摘要
目的观察髓芯减压术后自体皮质支撑骨及松质颗粒骨植骨治疗股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的疗效。方法2004年2月-2008年5月,采用股骨头髓芯减压结合自体皮质支撑骨及松质颗粒骨植骨治疗ONFH64例77髋。男45例,女19例;年龄23～60岁,平均43岁。单侧51例,双侧13例。酒精性39例47髋,激素性21例26髋,创伤性4例4髋。病程1～12年。髋关节疼痛2～14个月,平均7个月。患者均经影像学检查及术后病理检查确诊为ONFH。按国际骨科循环协会(ARCO)分期,ⅠA期17例23髋,ⅠB期2例3髋,ⅡA期21例24髋,ⅡB期2例2髋,ⅡC期4例4髋,ⅢA期18例21髋。术后行髋关节功能及影像学评估。结果术后59例69髋获随访,随访时间12～62个月,平均32.1个月。术后12个月髋关节Harris评分为(87.12±8.68)分,与术前(68.38±14.49)分比较差异有统计学意义(P<0.05);获优39髋,良18髋,可6髋,差6髋,优良率82.6%;评分为差的患者行人工全髋关节置换。影像学评估:Ⅰ级21髋(30.4%),Ⅱ级42髋(60.9%),Ⅲ级6髋(8.7%)。1例取髂骨区发生并发症并影响生活,21例发生轻度疼痛或麻木,余患者均无并发症发生。结论髓芯减压结合自体皮质支撑骨及松质颗粒骨植骨治疗ONFH,能有效阻止股骨头塌陷,加速病灶区骨组织修复,手术创伤小,可获得较好临床疗效。
Abstract： Objective To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head （ONFH）. Methods From February 2004 to May 2008, 64 patients （77 hi ps） with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases
（47 hi ps）, by steroid in 21 cases （26 hi ps）, and by trauma in 4 cases （4 hi ps）. The disease course was 1-12 years. The pain time was 2-14 months （average 7 months）. All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous （ARCO） international classification of osteonecrosis, 17 cases （23 hips） were classified as stage I A, 2 cases （3 hips） as stage I B, 21 cases （24 hips） as stage II A, 2 cases （2 hips） as stage II B, 4 cases （4 hips） as stage II C, and 18 cases （21 hips） as stage III A. The outcome was evaluated both cl inically by Harris score and radiologically by imageology. Results A total of 59 cases （69 hips） were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 ± 8.68 at 12 months after operation, showing significant difference （P 〈 0.05） when compared with the preoperative one （68.38 ± 14.49）. The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips （30.4%） of grade I, 42 hips （60.9%） of grade II, and 6 hips （8.7%） of grade III. One case had the compl ication of il ium bone donor site, 21 cases had l ittle pain or numbness, and the other cases had no uncomfortable compl ication. Conclusion The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Cl inical effects are obvious and effective.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第3期266-269,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨头缺血性坏死
髓芯减压
骨移植
Osteonecrosis of the femoral head Core decompression Bone graft
