股骨头坏死的不同治疗手段对血流动力学及预后的影响*

Effect of various treatments on hemodynamic changes and prognosis in patients with femoral head necrosis*

摘要:

目的 探讨不同治疗手段对股骨头坏死患者血流动力学及预后的影响。方法 选取2016年1月—2017年5月十堰市太和医院收治的67例股骨头坏死患者作为研究对象。根据采用手术方法的不同将患者分为研究组（髓芯减压微创植骨术）和对照组（全髋关节置换术）。统计患者收缩压（SBP）、舒张压（DBP）、心率（HR）的变化情况，并采用VAS评分法评价治疗前后疼痛程度，采用Harris评分评价患者髋关节的功能和疼痛情况，采用WHO生存质量测定量表对患者治疗前及治疗后生活质量进行评价，并记录并发症发生情况。结果 研究组患者治疗后10 min、12 及72 h的SBP、DBP、HR水平均高于对照组（P?<0.05），两组间的LVEF及SpO2均无差异（P?>0.05），研究组患者治疗后疼痛VAS评分低于对照组（P?<0.05），而治疗后Harris评分却高于对照组（P?<0.05），研究组患者治疗后心理领域、生理领域、环境领域、社会关系领域评分均高于对照组（P?<0.05），研究组患者出现感染、再次手术、褥疮、下肢血管栓塞、肺栓塞的比例均低于对照组（P?<0.05）。结论 髓芯减压微创植骨术对股骨头坏死患者血流动力学影响较小，并预后较好，值得在临床推广应用。

Abstract:

Objective To investigate the effect of different treatments on the hemodynamic changes and prognosis of patients with femoral head necrosis. Methods A total of 67 patients with femoral head necrosis who were admitted into our hospital from January 2016 to May 2017 were enrolled in this study. Patients were divided into two groups according to different surgical methods: minimally invasive bone grafting, and Total hip arthroplasty. SBP, DBP, HR, The VAS score, Harris score, and WHO quality of life measurement scale were recorded. Results Levels of SBP, DBP and HR at 10 min, 12 h, and 72 h after treatment were all higher in study group when compared with those in control group. VAS score was decreased while Harris score was increased significantly in study group when compared with those in control group. The patients in the study group exerted significant improvement in the field of psychology, physiology, environment and social relations after treatment than those in the control group. Incidence of infection, reoperation, bed sores, lower extremity vascular embolism, and pulmonary embolism was obviously decreased in study group compared with those in the control group. Conclusions Core decompression minimally invasive bone graft shows less impact on hemodynamics and better prognosis.