经转子髓芯减压植骨治疗股骨头缺血坏死

目的 总结经转子髓芯减压植骨术治疗股骨头缺血性坏效果。方法 ５３例股骨头缺血性坏死患者行经转子髓芯减压植骨术。其中Ｆｉｃａｔ分期Ⅱ期２１例,Ⅲ期２５例,Ⅳ期７例。结果 平均随访４．５年,髋关节功能优良率７５．５％。结论 经转子髓芯减压植骨术可有效治疗股骨头缺血性坏死,具有手术简单,不破坏股骨头残余血供,不妨碍日后行人工关节置换术等优点。     

活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死疗效观察

目的:观察活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死的临床疗效。方法:采用髓芯减压及自体骨移植术治疗早期股骨头坏死患者24例28髋,术后所有患者均口服活络骨康丸,服药时间为24个月,随访观察治疗前后髋关节功能Harris评分及临床疗效。结果:所有患者均获得随访,末次随访见患者髋关节功能较治疗前均有明显改善,未发生关节塌陷及二次手术者;术前及术后2年Harris评分比较,差异有统计学意义(P0.05)。结论:活络骨康丸联合髓芯减压及自体骨移植术治疗早期股骨头坏死可明显缓解疼痛症状、改善关节功能,效果满意。     

股骨头缺血性坏死保头治疗进展

目的综述股骨头缺血性坏死（avascular necrosis, AVN）保头治疗的研究进展. 方法广泛查阅近10年股骨头AVN保头治疗的相关文献,并对其综合分析. 结果股骨头AVN的保头治疗方法主要有髓芯减压、各种骨移植和截骨术.股骨头AVN早期通过手术修复可取得良好的治疗效果. 结论通过手术修复技术特别是吻合血管的游离腓骨移植,可使股骨头修复获得良好的长期疗效.     

髓芯减压BMP植入治疗股骨头坏死的血流量及病理改变

目的：研究股骨头坏死的早期治疗方法。方法：选取6月龄健康新西兰白兔42只，随机分组，注射激素制作股骨头坏死模型，行髓芯减压加植骨、髓芯减压植骨加BMP治疗，SPECT观察血流量的改变。结果：随着激素应用时间的延长，股骨头局部核素吸收量逐渐减少。应用激素第4周血流量降至正常的72%，6周为69%，8周为56%。髓芯减压术后2周恢复至正常的82%，4周时恢复正常。髓芯减压加BMP骨泥治疗组4周后镜下改变为大量新生骨形成，爬行替代坏死的骨小梁，且在新生骨周围有大量的新生血管形成。结论：髓芯减压术能改善坏死股骨头的血运，骨诱导蛋白（BMP）对坏死的股骨头具有骨诱导作用，能刺激新生骨的形成，爬行替代坏死的骨小梁，而且能刺激新生血管形成。     

髓芯减压植骨术与带肌蒂骨瓣移植术治疗股骨头坏死的效果比较

目的探讨股骨头髓芯减压植骨术与开窗减压带蒂骨瓣移植术治疗股骨头坏死的临床疗效比较。方法本院自2004-02—2012-02诊治的非创伤性成人早期股骨头缺血坏死58例(64髋),其中28例(32髋)采用髓芯减压植骨术治疗(A组),30例(32髋)采用开窗减压加带蒂缝匠肌骨瓣移植术治疗(B组)。记录2种手术方法的患者术前、术后一般状况、X线平片、Harris评分。结果本组获随访1~36个月,平均20个月。开窗减压带肌蒂骨瓣移植术术后复发率及远期髋关节活动情况较单纯髓芯减压植骨术效果好。结论开窗减压带蒂骨瓣移植术的临床疗效在股骨头坏死的早中期优于单纯髓芯减压植骨术。     

扩大髓芯减压带血管蒂髂骨瓣移植治疗成人股骨头缺血坏死

目的评价扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨治疗成人股骨头缺血坏死的临床应用价值。方法回顾性分析29例成人股骨头缺血坏死患者行扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨治疗前后的影像学表现、功能评分。结果所有患者的疼痛症状都得到一定程度的缓解,Harris评分都有显著提高,术后优良率达93%。结论扩大髓芯减压、并带旋髂深血管蒂髂骨瓣植骨术是治疗2、3期成人股骨头缺血坏死的有效方法。     

应用髓芯减压术联合通络生骨胶囊治疗早期股骨头坏死疗效观察

目的观察髓芯减压术联合通络生骨胶囊治疗早期股骨头缺血性坏死的效果。方法将60例早期股骨头缺血性坏死患者随机分为观察组对照组,各30例。对照组实施髓芯减压术治疗。观察组在髓芯减压术基础上加用生骨胶囊口服治疗。结果两组患者均获12个月随访。观察组总有效率为93.33%(28/30),对照组总有效率73.33%(22/30),两组差异有统计学意义(P0.05)。结论髓芯减压术结合通络生骨胶囊治疗早期股骨头坏死总有效率高且预后良好,疗效肯定。     

骨隧道搬移术治疗中晚期股骨头坏死的疗效观察

目的探讨骨隧道搬移术治疗中晚期股骨头坏死的疗效。方法中晚期股骨头坏死60例随机分为2组,髓芯减压组30例;骨隧道搬移术组30例。结果骨隧道搬移术组治疗有效率(96.7%)优于髓芯减压组(83.3%);两组治疗后Mayo髋关节功能评分之间差异无统计学意义(P>0.05)。结论骨隧道搬移术治疗中晚期股骨头坏死有效、安全。     

早期股骨头缺血性坏死的微创治疗

目的 应用髓芯减压自体骨髓细胞结合重组合异种骨移植的方法治疗早期股骨头缺血性坏死,探索早期股骨头缺血性坏死的微创治疗方法.方法 自2000～2002年采用上述术式治疗早期股骨头缺血性坏死患者48例（64侧）,年龄19～56岁,平均37岁;ARCO分期为Ⅰc期8侧,Ⅱa期23侧,Ⅱb期19侧,Ⅱc期14侧,全部病例均行髓芯减压自体骨髓细胞结合重组合异种骨移植术.术后随访2～4年,根据手术前后Harris评分变化,X线影像学表现及是否需要进一步治疗进行随访观察.结果 术后患者Harris评分平均提高16分（平均术前79分,术后95分）,影像学表现49侧保持稳定,2例（3侧）分别于术后9～20个月改行人工全髋关节置换术或带血管蒂骨瓣股骨头修复术而治愈.结论 髓芯减压自体骨髓细胞结合重组合异种骨移植治疗早期股骨头缺血性坏死,手术操作简单、减少了供区的并发症、术后恢复快,是一种值得提倡的微创手术方法.     

动脉灌注髓芯减压干细胞移植治疗股骨头坏死

目的评价动脉灌注加股骨头髓芯减压后注射干细胞治疗成人股骨头缺血性坏死的疗效。方法对30例成人股骨头缺血性坏死（ARCO分期ⅠA～ⅢA期）分别采用单纯动脉灌注、动脉灌注加股骨头髓芯减压、动脉灌注加股骨头髓芯减压后行干细胞移植三种方法治疗。术后采用髋关节Harris评分及影像学（主要为MRI）情况评定疗效。结果动脉灌注加股骨头髓芯减压后注射干细胞较另外两组在MRI表现上有明显差异（P〈0．05）。结论通过对早期股骨头缺血性坏死进行血管灌注、股骨头髓芯减压及自体骨髓干细胞注射的治疗,可以延缓或阻止股骨头缺血坏死、塌陷、变形的病理过程。     

介入和髓芯减压植骨治疗股骨头缺血性坏死

目的探讨介入和髓芯减压、坏死区域掏空植骨治疗股骨头缺血性坏死的疗效。方法对57例患者采用介入和髓芯减压、坏死区域掏空植骨。结果57例经1~4·5年(平均2·9年)随访,效果满意。结论该方法损伤小,操作简便,是治疗股骨头缺血性坏死的有效方法。     

Blood vessel implantation into ischemic bone

Blood vessel implantation, core decompression, and core decompression plus cancellous bone grafting were compared in 36 adult mongrel dogs to evaluate their relative effectiveness in revascularizing an ischemic femoral head. Each of the methods resulted in a reversal of the ischemic changes to varying degrees. Blood vessel implantation resulted in increased new bone formation at the site of vessel implantation but no significant revascularization in the peripheral portion of the femoral head. The method of creating avascular necrosis of the femoral head of the canine, as described by Hori, was studied in a controlled fashion. Although ischemic changes were noted in our hands, the model failed to produced findings consistent with avascular necrosis.     

Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation

The effectiveness of core decompression and bone grafting with and without electrical stimulation was investigated in patients with avascular necrosis (AVN) of the femoral head. One hundred sixteen hips with AVN had decompression and grafting; 74 were also treated with direct current (DC). The DC stimulation was via a coil inserted directly into the femoral head. These were compared to 55 hips with AVN treated nonoperatively. Hips treated with electrical stimulation showed less roentgenographic progression and achieved a better clinical score than hips treated with decompression and grafting alone. Both groups had a significantly lower incidence of arthroplasty than the nonoperated controls. One patient developed a pulmonary embolus, but there were no fractures or other complications. Decompression and grafting are safe and reasonably effective in retarding the progression of AVN. Supplemental electrical stimulation seems to improve the results even further.     

Avascular necrosis of the femoral head after femoral neck fracture

Trauma-induced avascular necrosis of the femoral head represents the most common femoral head aseptic necrosis. An alteration in blood supply to the femoral head is the cause of the vascular necrosis. Another mechanism in the genesis of femoral head necrosis is the tamponade effect. Femoral head necrosis may be asymptomatic for a long time, even in patients in whom late segmental collapse already is present. Radiography does not allow diagnostic reliability until 6 months after fracture. The presence of a low signal intensity band away from the fracture line on magnetic resonance images clearly delimits the necrotic area. Once segmental collapse has developed, the diagnosis becomes simple using plain radiographs. The treatment of established femoral necrosis complicating fractures of the upper end of the femur is approached as a therapeutic problem lacking an optimal solution. The main therapeutic options are femoral head-preserving procedures and joint reconstruction. Among the procedures that preserve the femoral head are joint unloading, femoral head core decompression, electric stimulation, osteotomy, and bone grafting. Joint reconstruction procedures including cup arthroplasty, hemiresurfacing, total hip resurfacing, femoral head replacement, femoral head endoprosthesis, and total arthroplasty will be reviewed.     

hVEGF165及hBMP-7共表达重组腺相关病毒载体对兔激素性股骨头坏死的修复作用研究

目的探讨hVEGF165及hBMP-7双基因共表达重组腺相关病毒载体对兔激素性股骨头坏死的修复作用。方法应用细菌脂多糖联合甲基强地松龙制备兔激素性股骨头坏死模型。30只经MRI筛选造模成功动物随机分为模型组、髓芯减压组和病毒治疗组。病毒治疗组动物于髓芯减压术后将rAAV-hVEGF165-IRES-hBMP-7病毒载体注入减压区内。选取病毒注射后12周时间点分别行核素骨扫描,股骨头大体观察、HE染色、VEGF和BMP免疫组化染色检测。结果 MRI检测、大体观察以及HE染色发现早期股骨头坏死动物模型建立成功,且病毒治疗组较髓芯减压组及模型组相比股骨头坏死表现明显减轻,VEGF及BMP表达增强,髓腔组织代谢旺盛,组间差别有统计学意义（P〈0.05）。结论重组腺相关病毒载体rAAV-hVEGF165-IRES-hBMP-7通过增加髓腔组织的血运、增强股骨头区骨组织质量提高激素性股骨头坏死区骨修复能力。     

Femoral osteotomies for avascular necrosis of the femoral head

Avascular necrosis of the femoral head affects 10,000 to 20,000 people every year and often these patients are in their 30s and 40s. The natural history of this disease is important to understand because the rate of femoral head collapse and treatment options are related to multiple factors including the cause of the disease, its stage at initial presentation, and the size and location of the lesion. Various treatment options have been purposed for different stages of avascular necrosis of the femoral head. Nonoperative treatments include protected weightbearing, electrical stimulation, and pharmacologic treatments. Operative treatment includes core decompression with or without grafting, debridement and grafting, osteotomy, fusion, hemiresurfacing, hemiarthroplasty, and total hip arthroplasty. The purpose of the current study was to discuss the history, indications, techniques, and results of proximal femoral osteotomies for the treatment of avascular necrosis of the femoral head.     

Drilling and cancellous bone grafting for avascular necrosis of the femoral head

Objectives  

Maintenance of form and function and prevention of further deterioration of avascular necrosis of the femoral head through core decompression and cancellous bone grafting.     

钻孔减压植骨和股方肌骨瓣植入治疗早期成人股骨头坏死的疗效比较

目的比较钻孔减压植骨术和病灶刮除股方肌骨瓣植入术治疗早期成人股骨头坏死（ONFH）的疗效,为临床治疗方案的选择提供参考。方法 54例（61髋）ONFH分别采用病灶刮除股方肌骨瓣植入术（骨瓣植入组,25髋）和钻孔减压植骨术（减压植骨组,36髋）治疗,比较2组手术一般情况、髋关节功能Harris评分、术后临床效果及手术失败率。结果减压植骨组术中出血量更少,切口长度、住院时间、更短,差异有统计学意义（P〈0.05）。2组术后12个月及末次随访时髋关节功能Harris评分较术前明显提高,差异有统计学意义（P〈0.05）;但2组术后6个月、12个月、末次随访时髋关节功能Harris评分差异无统计学意义（P〉0.05）。骨瓣植入组临床改善率为69.6%（16/23）,减压植骨组临床改善率为66.7%（24/36）,2组比较差异无统计学意义（χ2=0.054,P=0.816）。结论采用钻孔减压植骨和病灶刮除股方肌骨瓣植入术治疗早期ONFH的早期随访效果确切,但钻孔减压植骨术创伤更小,住时院时间更短。     

髓芯减压缝匠肌髂骨瓣移植治疗青壮年股骨头缺血性坏死

目的探讨和总结青壮年股骨头缺血性坏死的有效治疗方法。方法1994年9月～2003年8月,对68例75侧青壮年股骨头缺血性坏死患者行髓芯减压的同时清除股骨头内纤维组织及坏死骨,取缝匠肌髂骨瓣植入股骨头内。其中男57例63侧,女11例12侧;年龄16～58岁,平均42.5岁。左侧31例,右侧37例,双侧7例。致病原因:长期饮酒52例,长期服用激素6例,髋部外伤6例,不明原因4例。病程8个月～4年。Ficat分期:期10例11侧,期27例31侧,期31例33侧。结果术后68例获2年6个月～11年随访,平均5.2年。按Harris髋关节评分,优23例,良33例,可10例,差2例,术后无1例复发,优良率82.3%。结论股骨头髓芯减压法具有清除病灶彻底、减压充分、重建股骨头的血循环等特点,缝匠肌髂骨瓣植骨为股骨头带入成骨成分、血液供应,可加速骨的重建,适用于青壮年股骨头缺血坏死Ficat分期、、期患者,是一种较为有效的治疗方法。