本文選題：股骨頭壞死　切入點(diǎn)：前瞻性　出處：《西南醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察并對(duì)比介入灌注術(shù)聯(lián)合中藥與髓芯減壓植骨術(shù)聯(lián)合中藥在圍塌陷期(ARCOⅡ-Ⅲa期)股骨頭壞死治療中的療效,尋求圍塌陷期股骨頭壞死有效、可行的保髖療法。方法:篩選2010年1月至2014年12月在西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院就診的ARCO(Ⅱ-Ⅲa)期股骨頭缺血性壞死患者70例(80髖),依據(jù)治療方式的不同,將行介入灌注術(shù)聯(lián)合骨蝕一號(hào)方治療者設(shè)為介入組(35例40髖),行髓芯減壓植骨術(shù)聯(lián)合骨蝕一號(hào)方治療者設(shè)為減壓組(35例40髖),經(jīng)1年以上的隨訪,記錄患者的圍手術(shù)期指標(biāo)(住院時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、住院總花費(fèi))、Harris功能評(píng)分及影像學(xué)評(píng)定結(jié)果,然后用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:病例隨訪12~23個(gè)月,平均隨訪時(shí)間13.6個(gè)月。在80髖中,有4髖于隨訪期間病情加重接受了人工髖關(guān)節(jié)置換術(shù),1髖失訪,共計(jì)75髖,總結(jié)為如下四個(gè)方面:1.圍手術(shù)期指標(biāo):兩組患者住院時(shí)間的差異無統(tǒng)計(jì)學(xué)意義(t=2.514,P0.05);介入組手術(shù)時(shí)間較減壓組短;介入組術(shù)中出血量較減壓組少;介入組住院總花費(fèi)方面較減壓組少,且差異顯著(t=15.224,P0.05;t=13.247,P0.05;t=10.329,P0.05)。2.療效顯示,Harris功能評(píng)價(jià):優(yōu)47髖,優(yōu)秀率62.67%,良14髖,良好率18.67%,可6髖,尚可率8.00%,差8髖,無效率10.67%,總優(yōu)良率為81.33%;影像學(xué)評(píng)價(jià):穩(wěn)定56髖,穩(wěn)定率74.67%,加重19髖,加重率25.33%。3.組間分期比較:(1)在ARCOⅡ期中:介入組術(shù)后12個(gè)月髖關(guān)節(jié)Harris評(píng)分優(yōu)良率高于減壓組,差異顯著(x~2=5.249,P=0.033),而介入組術(shù)后12個(gè)月影像穩(wěn)定率與減壓組的差異無統(tǒng)計(jì)學(xué)意義(x~2=1.687,P=0.073);(2)在ARCOⅢa期中:介入組術(shù)后12個(gè)月髖關(guān)節(jié)Harris評(píng)分優(yōu)良率與減壓組的差異無統(tǒng)計(jì)學(xué)意義(x~2=1.541,P=0.077),而介入組術(shù)后12個(gè)月的影像穩(wěn)定率低于減壓組,且差異有統(tǒng)計(jì)學(xué)意義(x~2=2.416,P=0.044)。4.組內(nèi)分期比較:(1)在介入組中:ARCOⅡ期術(shù)后12個(gè)月髖關(guān)節(jié)Harris評(píng)分優(yōu)良率高于ARCOⅢa期,差異顯著(x~2=6.337,P=0.035),ARCOⅡ期術(shù)后12個(gè)月影像穩(wěn)定率高于ARCOⅢa期,差異顯著(x~2=9.247,P=0.034);(2)在減壓組中:ARCOⅡ期術(shù)后12個(gè)月髖關(guān)節(jié)Harris評(píng)分優(yōu)良率與ARCOⅢa期的差異無統(tǒng)計(jì)學(xué)意義(x~2=2.006,P=0.057),而ARCOⅡ期術(shù)后12個(gè)月影像穩(wěn)定率高于ARCOⅢa期,且差異顯著(x~2=6.478,P=0.031)。結(jié)論:1.在圍塌陷期,介入灌注聯(lián)合中藥療法與髓芯減壓植骨術(shù)聯(lián)合中藥療法均能改善ONFH的臨床癥狀、體征,穩(wěn)定影像學(xué)表現(xiàn);2.本研究初步顯示介入灌注聯(lián)合中藥療法與髓芯減壓植骨術(shù)聯(lián)合中藥療法的近期療效相當(dāng),但介入灌注聯(lián)合中藥療法在改善患者疼痛及關(guān)節(jié)功能方面優(yōu)于髓芯減壓植骨術(shù)聯(lián)合中藥療法;3.選擇恰當(dāng)?shù)臅r(shí)效性分期節(jié)點(diǎn)、運(yùn)用合理的保髖療法,可以獲得滿意的療效,本研究顯示介入灌注療法對(duì)于ARCOⅡ期患者具有較好的近期療效,而髓芯減壓植骨術(shù)對(duì)于ARCOⅢa期患者具有較好的近期療效;4.結(jié)合Harris功能評(píng)價(jià)及影像學(xué)評(píng)價(jià)進(jìn)行保髖治療的療效評(píng)價(jià)可能更加的客觀、并且評(píng)價(jià)效能更加全面;5.介入灌注療法具有經(jīng)濟(jì)方便、安全微創(chuàng)、迅速改善股骨頭內(nèi)外血運(yùn)障礙的優(yōu)點(diǎn);而髓芯減壓植骨術(shù)療法有改善股骨頭內(nèi)血運(yùn)障礙,并可糾正股骨頭生物力學(xué)不穩(wěn)定的優(yōu)勢。
[Abstract]:Objective: To compare the interventional therapy combined with Chinese medicine with core decompression and bone grafting combined with traditional Chinese medicine in pericollapse stage were observed (ARCO II - III a) curative effect of the treatment of femoral head necrosis, for pericollapse stage femoral head necrosis, hip preserving therapy feasible. Methods: from January 2010 to December 2014 in the medical screening of Southwest Hospital of traditional Chinese medicine Medical University Affiliated ARCO (a II - III) avascular necrosis of the femoral head in 70 cases (80 hips), according to different treatment methods, the Interventional Perfusion Combined with bone erosion a prescription treatment as the intervention group (35 cases, 40 hips) underwent core decompression and bone graft combined with bone erosion a no treatment as the decompression group (35 cases, 40 hips) after 1 years of follow-up, record the patient's perioperative indicators (hospitalization time, operation time, blood loss, intraoperative total hospitalization costs), the evaluation result of Harris score and imaging, then were analyzed by SPSS17.0. 緇撴灉:鐥呬緥闅忚12~23涓湀,騫沖潎闅忚鏃墮棿13.6涓湀.鍦，

本文編號(hào)：1627031