髓芯减压+同种异体骨打压植骨治疗早期股骨头坏死的疗效观察

目的探讨髓芯减压+同种异体骨打压植骨治疗早期股骨头坏死的临床疗效。方法采用微创下髓芯减压+同种异体骨打压植骨的方法对39例(46髋)股骨头缺血坏死患者进行治疗。所有患者术前行髋关节核磁共振检查,根据国际骨循环研究会分期分为Ⅰ期3髋、Ⅱa期16髋、Ⅱb期7髋、Ⅱc期11髋、Ⅲ期9髋。术后行髋关节平片检查。评估患者术前、术后髋关节Harris评分,评价术后临床疗效。结果所有病例中,激素相关病例22髋、酒精相关病例11髋、特发性13髋。所有病例平均随访26个月(9~48个月),Harris评分术前(66±6.6)分,术后(80.2±9.7)分。不同病因导致的股骨头坏死,术后Harris评分差异无统计学意义,术前不同分期的患者术后Harris评分及临床疗效差异无统计学意义。术后疗效,优7例、良23例、中4例、差12例。术后优良率65%。股骨头坏死早期患者术后优良率78%,Ⅱc期以后患者术后优良率52.6%。术后股骨头塌陷7例,有5例术前分期为Ⅱc期及以上。术后粗隆间骨折1例,术后感染1例,4例术后改行全髋关节置换术。余病例均未见明显进展。结论髓芯减压+同种异体骨打压植骨治疗早期股骨头坏死可获得满意的临床疗效,国际骨循环研究会分期早期患者术后可获得更高的优良率。

Outcome of the Treatment of Osteonecrosis of Femoral Head Using the Core Decompression with Bone Impaction Grafting

Objective To evaluate the outcome of core decompression with bone impaction grafting for the treatment of osteonecrosis of femoral head.Methods Totally 39 cases(46 hips)of osteonecrosis of femoral head were treated with core decompression and impaction bone grafting.According to the Association Research Circulation Osseous(ARCO)system,3 hips were graded for stage Ⅰ,16 for stage Ⅱa,7 for Ⅱb,11 for Ⅱc,and 9 for Ⅲ.The Harris hip score(HHS)was evaluated before operation and at the latest follow-up.Results In all these patients,22 hips had hormone-related lesions,11 had alcohol-related lesions,and 13 had idiopathic lesions. The average HHS was changed from(66±6.6)before surgery to(80.2±9.7)after surgery during an average follow-up of 26 months(from 9 to 48 months).The postoperative HHS showed no significant difference among osteonecrosis of femoral head due to different etiologies.Also,the postoperative HHS and clinical effectiveness were not significantly different among patients with different preoperative stages.The postoperative outcome was excellent in 7 cases,good in 23 cases,mild in 4 cases,and poor in 12 cases.The rate of excellent and good was 65% in this series,with 78% for patients with early stages and 52.6% for those with grade Ⅱc or higher lesions.The femoral head collapsed in 7 cases,and 5 of which were preoperatively graded as in stage Ⅱc and higher.The postoperative complications included intertrochanteric fracture(n=1)and infection(n=1).Four hips were converted to total hip arthroplasty.All of other hips had no obvious progression of osteonecrosis.Conclusions Core decompression with bone impaction allografting is effective for the treatment of osteonecrosis of femoral head.Patients with lesions in earlier ARCO stages can have better outcomes.