分析超选择血管介入联合髓芯减压植骨术对股骨头缺血性坏死患者疗效及并发症的影响。

简单随机抽样选邯郸市第二医院2020年1月至2023年1月收入的92例股骨头缺血性坏死患者行前瞻性研究，将患者随机数字表法分为研究组46例与对照组46例，其中研究组中男性25例、女性21例，年龄40~70岁，平均（56.59±6.21）岁；对照组中男性26例、女性20例，年龄42~70岁，平均（57.85±6.15）岁，对照组予以髓芯减压植骨术治疗，研究组予以超选择血管介入联合髓芯减压植骨术治疗，比较两组手术效果、Harris髋关节评分、并发症发生情况与生活质量（SF-36量表）的差异。

等级资料秩和检验结果显示，两组手术效果比较差异存在统计学意义（Z=12.699，P<0.05），且研究组优良率高于对照组（84.78% VS 50.00%）（χ²=12.662，P<0.05）。重复测量方差分析结果显示，术后2年，与对照组相比[（36.71±3.98）分、（34.28±4.54）分、（3.30±0.96）分、（3.33±0.90）分、（77.63±8.75）分]，研究组功能、疼痛、活动度、畸形、Harris髋关节评分[（40.74±3.82）分、（38.46±3.86）分、（3.89±0.97）分、（3.89±0.97）分、（86.98±8.16）分]明显更高（F=4.947、4.746、2.910、2.901、5.298，P<0.05）。两组术后并发症发生情况与总并发症发生率（4.35% VS 13.04%）比较差异无统计学意义（χ²=2.190，P>0.05）。两组术后2年SF-36量表各因子得分与术前比较均升高（t=10.748/8.895、9.078/6.221、7.860/4.977、6.165/4.224、5.918/4.519、11.746/10.577、5.820/3.773，P<0.05）；且研究组术后2年SF-36量表各因子得分[（61.09±7.26）分、（58.24±6.25）分、（68.06±7.21）分、（67.24±7.32）分、（64.17±8.21）分、（65.22±7.22）分、（65.13±6.14）分]均高于对照组[（55.45±7.12）分、（52.45±6.25）分、（61.25±6.21）分、（62.45±6.54）分、（60.12±7.22）分、（60.45±7.25）分、（61.24±6.12）分]（t=3.762、4.443、4.854、3.307、2.515、3.162、3.043，P<0.05）。

对股骨头缺血性坏死患者而言，超选择血管介入联合髓芯减压植骨术可获得较好手术效果，改善髋关节功能与生活质量。

To analyze the effect and complications of superselective vascular intervention combined with core decompression bone grafting in patients with avascular necrosis of femoral head.

A prospective study of 92 patients with ischemic necrosis of the femoral head from January 2020 to January 2023 in the Second Hospital of Handan City was selected by simple random sampling, and the patients were divided into 46 cases in the study group and 46 cases in the control group by random number table method, in which 25 males and 21 females were in the study group, with ages ranging from 40 to 70 years, with a mean of (56.59±6.21) years, and 26 males and 20 females were in the control group, with ages ranging from 42 to 70 years, with a mean of (57.85±6.15) years. The control group was treated with core decompression and bone grafting, and the study group was treated with super-selective vascular intervention combined with core decompression and bone grafting. The results, Harris hip score, complications and quality of life (SF-36 scale) were compared2 years after surgery between the two groups.

The results of rank sum test for hierarchical data showed that the difference in surgical outcomes between the two groups was statistically significant (Z=12.699, P<0.05), and the excellent rate in the study group was higher than that in the control group (84.78% VS 50.00%) (χ²=12.662, P<0.05). The results of repeated measures ANOVA showed that at 2 years postoperatively, compared with the control group [(36.71±3.98) points, (34.28±4.54) points, (3.30±0.96) points, (3.33±0.90) points, and (77.63±8.75) points], the study group's functionality, pain, mobility, deformity, and Harris Hip Score [(40.74± 3.82), (38.46±3.86), (3.89±0.97), (3.89±0.97), (86.98±8.16)] were significantly higher in the study group (t=4.947, 4.746, 2.910, 2.901, 5.298, P<0.05). There was no statistically significant difference in the occurrence of postoperative complications and total complication rate (4.35% vs 13.04%) between the two groups (χ²=2.190, P>0.05). The SF-36 scale scores of each factor were higher in both groups at 2 years after surgery compared with the preoperative period (t=10.748/8.895, 9.078/6.221, 7.860/4.977, 6.165/4.224, 5.918/4.519, 11.746/10.577, and 5.820/3.773, P<0.05); and the study group had an increase in SF-36 scale scores at 2 years after surgery compared with the preoperative period. 2-year SF-36 scale scores for each factor [(61.09±7.26), (58.24±6.25), (68.06±7.21), (67.24±7.32), (64.17±8.21), (65.22±7.22), (65.13±6.14)] were higher than those of the control group [(55.45±7.12)points,, (65.13±6.14)]) points, (52.45±6.25) points, (61.25±6.21) points, (62.45±6.54) points, (60.12±7.22) points, (60.45±7.25) points, and (61.24±6.12) points] (t=3.762, 4.443, 4.854, 3.307, 2.515, 3.162, 3.043, P<0.05).

For patients with avascular necrosis of the femoral head, superselective vascular intervention combined with core decompression and bone grafting can achieve better results, improve hip function and quality of life.