异体螺纹骨笼结合自体松质骨支撑治疗早期股骨头坏死的临床疗效

目的回顾性分析髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头坏死的临床疗效。方法2000年2月至2007年8月，治疗早期股骨头坏死患者73例78髋，男50例53髋，女23例25髋；年龄27～49岁，平均37岁。采用侧方小切口入路，行髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术。术后预防性静脉给予抗生素及抗凝治疗；3周内禁止负重，3周后可部分负重，然后逐步过渡至完全负重。采用Harris评分系统评估术后患髋功能的改善情况；术后3、6、12、18及24个月摄正、侧位x线片，观察股骨头修复情况及有无坏死进展。结果57例59髋获得随访，随访时间2—5．5年，平均3．5年。术后24个月进行疗效评估，优40例41髋，良8例9髋，可4例4髋，差（手术失败）5例5髋手术失败的5例患者中SteinbergⅡB期2例、IIC期3例。患者的Harris评分由术前的50～75分，平均（63．5±6．6）分，提高至术后的32～100分，平均（81．1±17．2）分（t=17．6，P=0．0026），其中手术失败患者的Harris评分由术前的51～61分，平均（53．6±3．9）分，降至术后的32～47分，平均（39．64-3．6）分（t=11．2，P=0．06）。Kaplan．Meier生存率曲线示术后24个月手术成功率为87．2％。X线片表现与临床症状、体征的改变基本相符。结论髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头缺血性坏死适合于SteinbergI、Ⅱ期股骨头坏死患者。

Clinical observation of core decompression in combination with allograft threaded cage insertion and decalcified bone matrix for the treatment of osteonecrosis of the femoral head

Objective To evaluate the clinical outcome associated with core decompression in combination with allograft threaded cage insertion and decalcified bone matrix in a consecutive series of patients with osteonecrosis of the femoral heads, especially its effects of preventing femoral heads collapsing and predisposing factors. Methods From February 2000 to August 2007, a series of 73 patients （78 hips） who had undergone core decompression in combination with allograft threaded cage insertion in our hospital were involved in this study. Postoperative care consisted of prophylactic intravenous antibiotic and antieoagulation therapy. Patients were instructed to be non-weight-beating for 3 weeks, to partial weight-bear for the next 3 weeks, and to weight bear as tolerated thereafter. The primary clinical outcome of this study was functional improvement assessed with the Harris hip score. Serial anteroposterior and lateral radiograms of the pelvis were taken at 3, 6, 12, 18, and 24 months post-operatively to analyze the process of osteonecrosis. Results Fifty-nine cases of all seventy-three patients （seventy-eight hips ） were retrospective studied after 24-month follow up. ＂excellent＂ for 41 hips, ＂good＂ for 9 hips , ＂fair＂ for 4 hips and ＂poor＂ for 5 hips. The mean pre-operative score was 63.5, the mean post- operative score was 81.1, with a mean improvement of 17.6 （P 〈0. 001 ）. Refer to the Kaplan-Meier curve, the success rate at twenty-four months postoperatively was 87.2%. Radiological changes coincided with clinical changes. Conclusion Core decompression in combination with allograft threaded cage insertion and decalcified bone matrix provides a minimally invasive surgical treatment option to treat early stage osteonecrotic hips （ stage I and Ⅱ） and prevent femoral heads collapsing, with clinical outcomes and success rates prior to other commonly used surgical procedures.