摘要目的 探讨激素性股骨头坏死早期诊断及保髋治疗的预后.方法 回顾性分析2010年1月至2017年6月确诊为单侧激素性股骨头坏死的患者73例,男27例,女46例;年龄(34.26±10.35)岁.ARCOⅠ期21例、Ⅱa期24例、Ⅱb期8例、Ⅱc期18例、Ⅲa期2例.对ARCOⅠ期21例患者采用限制负重及药物治疗;对Ⅱa、Ⅱb期32例患者行髓芯减压术;对Ⅱc、Ⅲa期20例患者行带旋股外侧血管蒂大转子骨瓣转移术.随访期间当Ⅰ期进展为Ⅱa、Ⅱb期后行髓芯减压术,Ⅱa、Ⅱb期进展为Ⅱc或Ⅲa期时行带旋股外侧血管蒂大转子骨瓣转移术,进展为Ⅲb期后采用带血管蒂骨瓣联合钽金属棒植入,进展为Ⅲc期及以上时行大转子骨瓣重建股骨头或关节置换术.评估Harris髋关节评分,以关节置换为终点绘制股骨头生存曲线.结果 73例均获得随访,平均随访时间为29个月(18~48个月).21例Ⅰ期患者经保守治疗后,14例(67%)未见影像学ARCO分期进展,6个月后3例进展为Ⅱb期、4例进展为Ⅱc期.32例Ⅱa、Ⅱb期患者术后25例(78%)未进展,4例6个月进展为Ⅲa期、1例6个月进展为Ⅲb期、2例12个月时进展为Ⅲc期.18例Ⅱc期患者术后14例(78%)未进展,2例6个月进展至Ⅲa期、1例24个月进展至Ⅲc期、1例42个月进展至Ⅳ期.2例Ⅲa期患者术后1例无进展,另1例36个月时进展至Ⅳ期.Harris髋关节评分以更换治疗方案前为评价终点,Ⅰ期患者治疗前Harris髋关节评分为(90.48± 5.36)分,末次随访时为(91.76±8.19)分,差异无统计学意义(t=1.231,P=0.402);Ⅱa、Ⅱb期患者从(75.22±8.30)分提高至(84.47±16.77)分,差异有统计学意义(t=5.624,P＜0.001);Ⅱc、Ⅲa期患者从(59.80±9.24)分提高至(77.75±20.75)分,差异有统计学意义(t=12.033,P＜0.001).4例患者最终接受了关节置换术,治疗后2年股骨头生存率为98.6%,4年为94.5%.结论 激素性股骨头坏死通过筛查获得早期诊断后可根据不同分期选择相应的保髋治疗方案,短期临床疗效良好.

abstractsObjective To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). Methods Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cas-es were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleed-ing risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. Results All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78% ) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in- creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of pa-tients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. Conclusion The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied.