开窗减压加脱钙人牙基质填塞配合中药治疗早期ANFH的临床研究

目的:探讨脱钙人牙基质材料经手术植入并配合中药口服治疗肝肾亏虚型的早期ANFH,预防坏死区塌陷的临床疗效。方法:观察2003年6月~2007年12月期间股骨头软骨开窗钻孔减压加脱钙人牙基质填塞并配合中药口服治疗ANFH患者25例34髋(牙基质组),经股骨头软骨开窗钻孔减压加自体骨植入治疗的ANFH患者25例33髋(自体骨组),对疼痛指数、临床疗效及影像学评估。结果:牙基质组治疗后1月VAS评分值3.87±0.17,第24个月JOA评分值72.83±16.81,治疗成功率79.41%;自体骨组治疗后1月VAS评分值4.45±0.15,第24个月JOA评分值75.15±7.56,治疗成功率84.84%。经统计学分析,治疗后1月2组VAS评分组间比较差异有统计学意义(P0.05);治疗后24个月2组JOA评分和治疗成功率比较差异无统计学意义(P0.05)。结论:经股骨头软骨开窗钻孔减压加脱钙人牙基质填塞手术配合中药口服治疗,能有效促进早期股骨头坏死区骨修复,预防坏死区塌陷;而且脱钙人牙基质来源广、提取易、成本低,诱导骨修复疗效确切,不涉及医学伦理问题。

Effect of Core Drilling Decompression combined with DDM Transplantation and Chinese Medicine on the Patients of Avascular Necrosis of Femoral Head

Objective：To evaluate the clinical effect of core drilling decompression combined with the demineralized dentin matrix（DDM） transplantation and Chinese medicine on patients of avascular necrosis of femoral head（ANFH） which were in deficiency of both liver and kidney during ARCO stageⅠ＆Ⅱ.Methods：Twenty-five patients（34 hips） were treated with core drilling decompression combine with the DDM transplantation and Chinese medicine;another 25 patients（33 hips） were treated with core drilling decompression combined with the bone transplantation.All the patients were followed up for 24 months at least.JOA standard,VAS and X-ray were used to evaluate the effect of the 2 methods.Results： In DDM transplantation group,the VAS score was 3.87±0.17 one month after the operation and the JOA scores was 72.83±16.81 two years after the operation,the success rate being 79.41%.While in bone transplantation group,the VAS scores was 4.45±0.15 one months after the operation and the JOA scores was 75.15±7.56 two years after the operation,the success rate being 84.84%.There was statistically significant difference between two groups in the VAS scores one month after the operation（P〈0.05）,but there was no statistically significant difference between groups in JOA scores 24 months later（P〈0.05）.Conclusion： The treatment of core drilling decompression combine with the DDM transplantation and Chinese medicine is of great efficiency for the treatment of ANFH.