钻孔减压配合髓腔内药物灌注治疗塌陷前股骨头坏死的早期临床观察

目的：观察钻孔减压配合髓腔内药物灌注治疗塌陷前股骨头坏死的临床疗效。方法：根据国际骨循环研究学会（Association Research Circulation Osseous，ARCO）骨坏死分期标准，选取ARC0分期属I期、Ⅱ期的股骨头坏死患者60例，随机分为治疗组30例，对照组30例。治疗组行钻孔减压术时经孔道注入丹参酮ⅡA注射液2mL，术后1月开始行髓腔内丹参酮ⅡA注射液灌注治疗，每周治疗1次，连续治疗4次为1个疗程，休息2个月后，再进行下1疗程，本组病人治疗2个疗程。对照组仅行钻孔减压术治疗。结果：所有患者均获得6个月以上随访，行Harris评分和影像学检查。（1）髋关节Harris评分：治疗组由术前（70．50±13．17）分升至（92．70±10．84），对照组由术前（70．82±13．64）分升至（78．09±10．53）分，经t检验进行比较分析，两组治疗前后比较差异有统计学意义（P〈0．05），治疗后两组间比较差异有统计学意义（P〈0．05）。（2）髋关节影像学检查，两组病例治疗6个月后复查髋关节MRI，病变无明显进展。经ARC0分期评价，两组病例治疗前后分期无变化，经秩和检验分析P〉0．05差异无统计学意义。结论：钻孔减压配合髓腔内药物灌注治疗塌陷前股骨头坏死是一种安全、有效的方法，但还需大样本长期随访进一步验证。

Preliminary Report on Marrow Cavity Injection Coordinating with Core Decompression for Treating of the Early Stage of Osteonecrosis of the Femoral Head

Objective： To observe the therapeutic effect of marrow cavity injection coordinating with core decompression treatment with osteonecrosis of the femoral head at early stage. Methods.. Sixty patients with osteonecrosis of the femoral head at stage I or Ⅱ were included in the study, according to the system of the Association Research Circulation Osseous （ARCO）. The patients were randomly divided into the experimental group （n= 30） and control group （n= 30）. The exper- imental group underwent core decompression and implantation 2ml of Tanshinone Ⅱ A injection, the patients underwent marrow cavity injection once a week for 4 times after one month. The injection was repeated again after two months resto- ration. The control group was only treated with core decompression. All patients were followed up for at least 6 months. Harris hip scores and radiographic progression detected by MRI were collected. Results.. （1） The Harris scores of patients in experimental group increased significantly from 70.50± 13.17 to 92.70 ± 10.84, and increased from 70.82 ± 13.64 to 78.09 ±10.53 in the control group （P〈0.05）. （2） The MRI outcomes were unchanged both in two groups after the treatment （P〉0.05）. Conclusion.. Marrow cavity injection coordinating with core decompression is a safe and effective treatment for osteonecrosis of the femoral head at early stage. Long-term follow-up and more cases are needed to confirm.