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題名 | Core Decompression in Treating Ischemic Necrosis of the Femoral Head=中心減壓術治療缺血性股骨頭壞死 |
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作者姓名(中文) | 張明超; 陳天雄; 羅惠熙; | 書刊名 | 中華醫學雜誌 |
卷期 | 60:3 1997.09[民86.09] |
頁次 | 頁130-136 |
分類號 | 416.26 |
關鍵詞 | 中心減壓術; 股骨頭; 缺血性壞死; Core decompression; Femoral head; Ischemic necrosis; |
語文 | 英文(English) |
中文摘要 | 背景:自從1971年Ficat發表用中心減壓術來治療缺血性股骨頭壞死之後,此種手術已被廣範使用來治療早期股骨頭壞死。但是各家所報告之結果差異頗大, 其成功率在30%至90%之間,所以中心減壓術對治療缺血性股骨頭壞死之效果仍未定論。 方法:從1980年3月至1993年12月,共有91位病人(110個缺血性股骨頭壞死)在臺北榮民總醫院接受中心減壓術之治療。其中有20位病人無法追蹤,其餘71位病人(84個缺血性壞死之骨頭)被列入本院研究中。其中49個股骨頭壞死由服用類固醇造成,20個原因不明,14個與酗酒有關,以及一個是外傷造成。壞死之程度採用Steinberg之分類,第一期有25個股骨頭,第二期有32個,第三期有9個,第四期有17個,第六期有一個。平均追蹤時間是56.7個月,其範圍從24個月到165個月。 結果:有22個股骨頭(26.19%)被列為「差」之結果,這些股骨頭因為情況惡化而需要換成人工關節。37個股骨頭(44.05%)被列為「可」之結果,因為其股骨頭塌陷且合併中度疼痛。有9個股骨頭(10.71%)列為「佳」之結果,由於其股骨頭稍有塌陷,且只有偶爾之髖部疼痛。有16個股骨頭(19.05%)被列為「優」之結果,因為股骨頭沒有變化,且沒有髖部疼痛。若將這些壞死之股骨頭分成兩組;類固醇組(49個)及非類固醇組(35個)。在類固醇組有9個股骨頭屬於「差」,27個「可」,5個「佳」,8個「優」。 非類固醇組之結果13個「差」,10個「可」,4個「佳」,8個「優」。整體來說,「佳」以上者只有30%。 結論:中心減壓術對於缺血性股骨頭壞死引起之疼痛有短時間減輕之功效,但對此種疾病之變化並無預防之功能。 |
英文摘要 | Background: The application of core decompression in the treatment of ischemic necrosis of femoral head (INFH) is to preserve the joint at early stage of the disease. Although excellent results have been obtained in many series, its effectiveness is questionable because of high rates of failure. This study is to evaluate the effectiveness of this technique in our patients with INFH receiving core decompression as the sole treatment. Methods: Although 91 patients were treated with core decompression in Veterans General Hospital-Taipei from 1980 to 1993, only 71 were considered as the valid cases after having been followed for 24 to 165 months (mean 56.7 months). Of 84 hips treated, 49 hips were steroid induced, 20 idiopathic, 14 alcohol related, and one related to trauma. Twenty-five hips were at Steinberg stage I, 32 at stage II, nine at stage III, 17 at stage IV, and one at stage VI. Results: The results were poor in 22 (26.19%) hips since the patients required hip prosthesis. Fair results were rated in 37 (44.05%) hips since progressive collapse occurred in the femoral head and the patients suffered from moderate hip pain. Good results were found in nine (10.71%) hips since the lesion showed no progression and the patients had only occasional pain. Excellent results were obtained in 16 (19.05%) hips since the patients had no pain and the lesion had no progressive change. The satisfactory rate in the nonsteroid-related hips (33% or 12/35) was significantly higher than in the steroid-related hips (27% or 13/49). The overall satisfactory result was only 30%. Conclusions: Although core decom-pression may not be effective in preventing progression of INFH, it may relieve temporary pain and delays the need for hip arthroplasty in some patients. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。