髓芯减压加硫酸钙人工骨植入治疗股骨头坏死临床研究
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摘要
目的探讨采用股骨头髓芯减压加碳酸钙人工骨植入术治疗股骨头缺血性坏死的疗效。方法 2010年5月至2013年6月,采用股骨头髓芯减压加植骨术治疗FicatⅠ-Ⅲ期股骨头缺血性坏死患者42例;年龄27-57岁。术前疼痛时间6-18个月,平均10个月。所有患者于术前、术后3个月和6个月行Harris评分,并进行双髋关节X线片及CT检查。结果所有病人随访6-36个月,平均18个月。Harris评分术后3个月、术后6个月均较术前显著上升,且术后6个月显著高于术后3个月,P<0.01。术后3个月及术后6个月的临床疗效较术前显著改善,P<0.01;且术后6个月的临床疗效显著优于术后3个月,P<0.05。术后3个月及术后6个月患者的影像学稳定率较术前显著改善,P<0.01;且术后6个月的影像学稳定率显著优于术后3个月,P<0.05。术后6个月,37例病人X线片显示髋关节保持基本生理形态,无明显坏死进展,CT显示坏死区不同程度修复,3例单髋症状加重,1例术后3月显示股骨头坏死加重,选择手术,1例因外伤后造成骨股颈骨折后选择手术治疗。结论股骨头髓芯减压加硫酸钙人工骨植入术治疗股骨头缺血性坏死具有手术损伤小,关节功能恢复快,临床症状明显减轻,短期效果满意的优点,长期疗效值得期待。
Objective To explore the use of femoral medullary core decompression with calcium carbonate artificial bone implantation for the treatment of ischemic necrosis of femoral head. Methods In May 2010 to June 2013, the thigh bone marrow core decompression for the treatment of bone graft Ficat Ⅰ- Ⅲ options were 42 patients with ischemic necrosis of bone;Age 27-57,preoperative pain 6 to 18 months, an average of 10 months. All of the patients in the preoperative and postoperative 3 months and 6 months Harris score, and dual hip X-ray and CT examination. Results All patients were followed up for 6 to 36 months, an average of 18 months. Harris score at 3 months, 6 months after operation compared with preoperative rise sharply(P<0.01).After 3 months and 6 months the clinical curative effect of preoperative significantly improved, P<0.01; And the clinical curative effect of postoperative 6 months was superior to that of postoperative 3 months, P<0.05. Patients with postoperative 3 months and 6 months after the imaging stability factor of the preoperative improved significantly, P<0.01; And 6 months after imaging stability factor significantly better than 3 months postoperatively, P<0.05.6 months postoperatively, 37 cases of patients with X-ray shows hip keep basic form, no obvious necrosis, CT showed necrosis area, different degree of repair, 3 cases of single hip symptoms worsen, 1 case of postoperative march showed femoral head necrosis is aggravating, choose operation, 1 case of femoral neck fracture caused by trauma after bone choice after surgery. Conclusions Marrow core decompression plus calcium sulphate artificial femoral head bone implantation treatment of ischemic necrosis of femoral head with a small surgical injury, quicker recovery of joint function, relieve clinical symptoms, the advantages of the short-term effect is satisfied, curative effect is worth looking forward to for a long time.
Objective To explore the use of femoral medullary core decompression with calcium carbonate artificial bone implantation for the treatment of ischemic necrosis of femoral head. Methods In May 2010 to June 2013, the thigh bone marrow core decompression for the treatment of bone graft Ficat Ⅰ- Ⅲ options were 42 patients with ischemic necrosis of bone;Age 27-57,preoperative pain 6 to 18 months, an average of 10 months. All of the patients in the preoperative and postoperative 3 months and 6 months Harris score, and dual hip X-ray and CT examination. Results All patients were followed up for 6 to 36 months, an average of 18 months. Harris score at 3 months, 6 months after operation compared with preoperative rise sharply(P<0.01).After 3 months and 6 months the clinical curative effect of preoperative significantly improved, P<0.01; And the clinical curative effect of postoperative 6 months was superior to that of postoperative 3 months, P<0.05. Patients with postoperative 3 months and 6 months after the imaging stability factor of the preoperative improved significantly, P<0.01; And 6 months after imaging stability factor significantly better than 3 months postoperatively, P<0.05.6 months postoperatively, 37 cases of patients with X-ray shows hip keep basic form, no obvious necrosis, CT showed necrosis area, different degree of repair, 3 cases of single hip symptoms worsen, 1 case of postoperative march showed femoral head necrosis is aggravating, choose operation, 1 case of femoral neck fracture caused by trauma after bone choice after surgery. Conclusions Marrow core decompression plus calcium sulphate artificial femoral head bone implantation treatment of ischemic necrosis of femoral head with a small surgical injury, quicker recovery of joint function, relieve clinical symptoms, the advantages of the short-term effect is satisfied, curative effect is worth looking forward to for a long time.
引文
1.张洋,王健,史占军.国外有关早期股骨头坏死外科治疗方法的选择.[J/CD].中华关节外科杂志(电子版),2012,6(2):287-297.
2.Bozic KJ,Zurakowski D,Thornhill TS.Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head.J Bone Joint Surg Am,1999,81:2009.
3.Nelson LM,Clark CR.Efficacy of phemister bone grafting in non-traumatic aseptic necrosis of the femoral head[J].J Arthroplasty,1993,8(3):253-258.
4.中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组.成人股骨头坏死诊疗标准专家共识(2012年版).[J].中国骨与关节外科,2012,5(2):185-192.
5.李宇,肖琳,孙小科,等.髓芯减压结合复合人工骨治疗早期股骨头坏死的疗效分析.[J].中国骨与关节损伤杂志,2013,28(4):342-343.
6.陈勇喜,农新盛,黄超.介入结合经皮髓芯减压植骨治疗股骨头缺血性坏死.[J].临床骨科杂志,2012,15(5):511-513.
7.刘德淮.髓芯减压植骨术治疗早、中期股骨头缺血性坏死的中期随访观察.[D].广西医科大学,2012.
8.邹涛.钽棒植入术和髓芯减压植骨术治疗早期股骨头坏死的临床研究.[D].山东中医药大学,2012.
9.赵合意,马国驹,李亚峰,等.髓芯减压自体松皮质骨加脱钙人牙基质材料混合植入治疗成人股骨头坏死.[J].实用医学杂志,2011,27(15):2785-2786.
10.Glueck C J,Freiberg R,Tracy T,et al.Thrombophilia and hypofibrinolysis:pathophysiologies of osteonecrosis[J].ClinOrthop Relat Res,1997,334(1):43-56.
11.Stulberg BN.Optimizing the outcome of core decompression[J].Orthopaedics,2001,16(1):24-31.
12.尚咏,虞攀峰,赵旭红.髓芯减压钽棒+自体骨植入治疗成人早期股骨头缺血性坏死的短期疗效观察.[J].山西医科大学学报,2013,44(3):240-244.
13.刘耀升,刘蜀彬.早中期股骨头坏死保留关节的手术治疗进展.[J/CD].中华损伤与修复杂志(电子版),2012,7(5):528-531.
14.李康养,黄永翔,李艳玲.镜下髓芯减压BAM骨诱导人工骨治疗股骨头坏死的临床研究.[J].海南医学院学报,2012,18(11):1557-1562.
2.Bozic KJ,Zurakowski D,Thornhill TS.Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head.J Bone Joint Surg Am,1999,81:2009.
3.Nelson LM,Clark CR.Efficacy of phemister bone grafting in non-traumatic aseptic necrosis of the femoral head[J].J Arthroplasty,1993,8(3):253-258.
4.中华医学会骨科分会显微修复学组及中国修复重建外科专业委员会骨缺损及骨坏死学组.成人股骨头坏死诊疗标准专家共识(2012年版).[J].中国骨与关节外科,2012,5(2):185-192.
5.李宇,肖琳,孙小科,等.髓芯减压结合复合人工骨治疗早期股骨头坏死的疗效分析.[J].中国骨与关节损伤杂志,2013,28(4):342-343.
6.陈勇喜,农新盛,黄超.介入结合经皮髓芯减压植骨治疗股骨头缺血性坏死.[J].临床骨科杂志,2012,15(5):511-513.
7.刘德淮.髓芯减压植骨术治疗早、中期股骨头缺血性坏死的中期随访观察.[D].广西医科大学,2012.
8.邹涛.钽棒植入术和髓芯减压植骨术治疗早期股骨头坏死的临床研究.[D].山东中医药大学,2012.
9.赵合意,马国驹,李亚峰,等.髓芯减压自体松皮质骨加脱钙人牙基质材料混合植入治疗成人股骨头坏死.[J].实用医学杂志,2011,27(15):2785-2786.
10.Glueck C J,Freiberg R,Tracy T,et al.Thrombophilia and hypofibrinolysis:pathophysiologies of osteonecrosis[J].ClinOrthop Relat Res,1997,334(1):43-56.
11.Stulberg BN.Optimizing the outcome of core decompression[J].Orthopaedics,2001,16(1):24-31.
12.尚咏,虞攀峰,赵旭红.髓芯减压钽棒+自体骨植入治疗成人早期股骨头缺血性坏死的短期疗效观察.[J].山西医科大学学报,2013,44(3):240-244.
13.刘耀升,刘蜀彬.早中期股骨头坏死保留关节的手术治疗进展.[J/CD].中华损伤与修复杂志(电子版),2012,7(5):528-531.
14.李康养,黄永翔,李艳玲.镜下髓芯减压BAM骨诱导人工骨治疗股骨头坏死的临床研究.[J].海南医学院学报,2012,18(11):1557-1562.