河南省教育厅科学技术研究重点项目 (编号：14A360023)；河南中医药大学科研苗圃工程项目 (编号：MP2020-8)
1.The Second Ailiated Hospital of Henan Traditional Chinese Medicine University， Henan Province Hospital of Traditional Chinese Medicine;2.Henan University of Traditional Chinese Medicine
[目的] 探讨双侧不同质塌陷股骨头坏死一期换髋与保髋治疗的临床疗效。[方法] 2018年10月—2019年6月本院治疗双侧非同质股骨头坏死患者28例，均实施一期换髋与保髋治疗，比较两侧围手术期、随访和影像资料。[结果] 所有患者顺利完成手术。保髋侧手术时间、切口长度、术中失血量、术后引流量均显著低于换髋侧，差异有统计学意义（P<0.05）。随时间推移，两侧术后VAS评分较术前均显著降低（P<0.05），髋屈-伸ROM、内-外旋ROM、Harris评分显著增加（P<0.05）；术后6个月及末次随访时两侧VAS评分及Harris评分差异无统计学意义（P>0.05），换髋侧髋屈-伸ROM、内-外旋ROM优于保髋侧（P<0.05）。影像方面，末次随访时，与术前相比，换髋侧PDIT、FO显著增加（P<0.05），保髋侧无显著变化（P>0.05），两侧PDIT、FO差异均无统计学意义（P>0.05）。[结论] 一期换髋与保髋治疗双侧不同质塌陷股骨头坏死，保髋侧可以获得与换髋侧相当的近期临床效果，能够延缓甚至避免关节置换。
[Objective] To investigate the clinical efficacy of one-stage hip replacement and hip preservation for bilateral femoral head necrosis with different degrees of collapse. [Methods] From October 2018 to June 2019, 28 patients with bilateral different degrees of femoral head necrosis were treated in our hospital. All patients were treated with one-stage hip replacement and hip preservation. Perioperative period, follow-up and imaging data of both sides were compared. [Results] All patients completed the operation successfully. The operative time, incision length, intraoperative blood loss and postoperative drainage of the hip preserving side were significantly lower than those of the hip replacement side, with statistical significance (P<0.05). As time went on, VAS scores on both sides were significantly lower than those before surgery (P<0.05), and hip flexor-extension range of motion (ROM), internal-external rotation ROM and Harris scores were significantly increased (P<0.05). There was no significant difference in VAS scores and Harris scores between the two sides in 6 months after surgery and the last follow-up (P>0.05). The hip flexor-extension ROM and the internal - external rotation ROM at the hip replacement side were better than those at the hip preservation side (P<0.05). In terms of imaging, by the time of the latest follow-up, PDIT and FO at the hip replacement side were significantly increased (P<0.05), while there was no significant change at the hip preservation side (P>0.05). There were no significant differences in PDIT and FO between the two sides at the last follow-up (P>0.05). [Conclusion] One-stage hip replacement and hip preservation in the treatment of bilateral femoral head necrosis with different degrees of collapse can achieve the same clinical effect as hip replacement, and can delay or even avoid joint replacement.