磷酸三钙多孔生物陶瓷修复股骨头坏死

背景：股骨头坏死保存自身关节的治疗是临床难点，使用各种人工骨替代植骨是临床探索目标之一。目的：回顾性分析股骨头颈交界开窗灯泡状病灶清除打压植骨结合磷酸三钙多孔生物陶瓷植入治疗股骨头坏死的有效性。方法：于2008年1至12月间使用此方法治疗股骨头坏死58例（88髋）。采用Harris评分系统评估治疗后患髋功能的改善情况，并于治疗后3，6，12个月及每年定期行X射线和CT检查进行影像学评估。结果与结论：56例患者（85髋）获得随访2-5年，其中ARCO分期：Ⅱ期27髋，Ⅲa 40髋，Ⅲb 18髋，按中日友好医院分型：C型4髋，L1型15髋，L2型28髋，L3型38髋。参考Harris评分系统，优55髋，良12髋，可5髋，差13髋。其中保头失败的患者中有9例11髋实施人工关节置换。患者治疗前的Harris评分平均为61.2分，治疗后2年平均为85.3分，平均提高了24.1分（P＆lt;0.001）。髋关节影像学表现稳定，股骨头内成骨明显，植骨区密度增高，磷酸三钙多孔生物陶瓷替代时间为1-1.5年。结果可见磷酸三钙多孔生物陶瓷植入治疗股骨头坏死临床效果满意，磷酸三钙多孔生物陶瓷有利于骨坏死的修复和重建，可在坏死区外侧柱起到支撑作用，有效防止进一步塌陷，是股骨头坏死患者尤其是保存自身关节的有效生物材料。

Porous bioceramic beta-tricalcium phosphate for treatment of osteonecrosis of the femoral head

BACKGROUND：It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage. OBJECTIVE：To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head. METHODS：From January to December 2008, 58 patients （88 hips） who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. Al patients were evaluated both clinicaly and radiographicaly at postoperative 3, 6, 12 months and annualy. Functional improvement was assessed with the Harris hip score. RESULTS AND CONCLUSION： Among these patients, 56 patients （85 hips） were folowed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excelent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The＆amp;nbsp mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points （P ＆lt; 0.001）. All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role in the lateral column of the necrotic area, and further prevent collapse, which is suitable for patients with osteonecrosis of the femoral head, especially for those with joint preservation.