镜下髓芯减压BAM骨诱导人工骨治疗股骨头坏死的临床研究

目的:评估关节镜辅助下髓芯减压植入BAM骨诱导人工骨与自体骨髓细胞治疗早期股骨头坏死可行性和临床疗效。。方法:将2009～2011年确诊的股骨头坏死按Ficat分期Ⅱ期25例30髋,Ⅲ期5例6髋;在C型臂透视定位及关节镜辅助下,有效准确地进行髓芯减压,对股骨头内病变组织清除彻底,改善股骨头内外环境,植入BAM骨诱导人工骨与自体骨髓细胞。术后3、12、24个月进行随诊,以Harris髋关节评分、X线片及MRI观察病变分期稳定性及临床疗效为评价指标。结果:全部病例随访12～24个月,按髋关节Harris评分,总优良率为86.11%。X线片显示股骨头部位有较好的骨修复,MRI显示病灶区信号无明显降低。结论:关节镜辅助下髓芯减压植入BAM骨诱导人工骨与自体骨髓细胞,具有诊断和定位准确,手术微创化特点,可用于治疗Ⅱ期,ⅢA期股骨头坏死患者。

Treatment with BAM artificial bone and autogenous marrow cells implantation after arthroscopic core decompression for ischemic necrosis of femoral head

Objective: To evaluate the feasibility and clinical effects of treatment with BAM artificial bone and autogenous marrow cells implantation after arthroscopic core decompression for ischemic necrosis of femoral head.Methods:From 2009 to 2011,25 cases(30 hips) at Ficat stage Ⅱ and 5 cases(6 hips) at Ficat stage Ⅲ were selected,and had arthroscopic core decompression with the assistance of arthroscopy and the localization of C-shaped fluoroscopic machine.Lesion tissues were cleared completely,internal and external environment of femoral head was improved and transplantation of the BAM induced artificial bone and autogenous marrow cells was performed.Follow up were conducted for 3,12 and 24 months after the operation.Harris hip score,X-ray and MRI were performed to evaluate the stability of staging and clinical effect.Results:All patients were followed up for 12 to 24 months.According to Harris hip score,total excellent and good rate was 86.11%.X-ray showed good bone repairment,and MRI showed no significant decrease in sign of focal zone.Conclusions:Minimally invasive grafting BAM artificial bone and autogenous marrow cells by core decompression under arthroscopy shows advantage of exact diagnosis and localization,as well as minimally invasion.It is effective in the treatment of ischemic necrosis of the femoral head at stageⅡand stageⅢA.