打压植骨与髓芯减压治疗ARCOⅡ期非创伤性股骨头坏死的疗效对比  

Comparison of core decompression and impacted bone grafting in treating ARCO Ⅱ non-traumatic osteonecrosis of the femoral head

作　　者：徐鑫 孙伟[1,2] 吴鑫杰 时利军[1,2] 范骁宇 王培旭 李子荣 孔隽 XU Xin;SUN Wei;WU Xinjie;SHI Lijun;FAN Xiaoyu;WANG Peixu;LI Zirong;KONG Jun(Department of Orthopaedics,China-Japan Friendship Hospital,Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100029;Center for Osteonecrosis and Joint Preserving&Reconstruction,China-Japan Friendship Hospital,Beijing 100029;Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029;Department of Radiological Diagnosis,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院中日友好医院骨科,北京100029 [2]中日友好医院骨坏死与关节保留重建中心,北京100029 [3]北京大学中日友好临床医学院,北京100029 [4]中日友好医院放射诊断科,北京100029

出　　处：《中华骨与关节外科杂志》2022年第6期404-410,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82072524);中日友好医院横向课题(2022-HX-9)

摘　　要：目的:基于中日友好医院(CJFH)分型、国际骨循环研究协会(ARCO)分期和危险因素,比较股骨头颈部开窗打压植骨术(IBG)与髓芯减压(CD)联合自体骨髓干细胞移植术治疗ARCOⅡ期非创伤性股骨头坏死(ONFH)的临床疗效。方法:回顾性纳入2015年1月至2020年12月收治的ARCOⅡ期非创伤性ONFH患者113例135髋,其中CD组51例60髋和IBG组62例75髋。采用CJFH分型和ARCO分期系统对患者进行分类。收集患者术前、术后Harris髋关节评分(HHS),随访进行X线及CT检查,对比分析两组患者的生存率及危险因素。结果:两组患者总体临床失败率比较,差异无统计学意义。而对于CJFH L2型(89.2%vs.69.0%,P=0.047)、L3型(57.1%vs.16.7%,P=0.033)或ARCOⅡC期(74.5%vs.48.4%,P=0.016)患者,IBG组的3年生存率明显高于CD组。CJFH分型是两组手术失败的危险因素,而ARCO分期仅影响CD组。结论:CD联合自体骨髓干细胞移植与股骨头颈部开窗IBG都是治疗ARCOⅡ期非创伤性ONFH的有效方法。但对于CJFH L2、L3型或ARCOⅡC期患者,IBG的治疗效果更好。外侧柱是否受累及受累程度是影响手术失败的危险因素,而坏死面积大小仅影响CD联合自体骨髓干细胞移植术的预后,对股骨头颈部开窗IBG无影响。Objective:To compare the clinical outcomes of impacted bone grafting and core decompression combined with autologous bone marrow stem cell grafting in treatment of ARCOⅡnon-traumatic osteonecrosis of the femoral head(ONFH)based on China-Japan Friendship Hospital(CJFH)typing and Association Research Circulation Osseous(ARCO)staging and risk factors.Methods:Totally113 patients(135 hips)with ARCOⅡnon-traumatic osteonecrosis of the femoral head admitted from January 2015 to December 2020were involved in this retrospective study including 51 patients(60 hips)undergoing core decompression(CD group)and 62 patients(75hips)undergoing impacted bone grafting(IBG group).Patients were categorized using CJFH typing and ARCO staging system.Harris hip scores(HHS)before and after operation were collected and X-ray and CT scan were conducted during the follow up.Survival time and clinical risk factors were compared between the two groups.Results:Clinical failure rates did not differ significantly between the two groups.For patients belonging to CJFH type L2(89.2%vs.69.0%,P=0.047),type L3(57.1%vs.16.7%,P=0.033)or stage ARCOⅡC(74.5%vs.48.4%,P=0.016),impacted bone grafting offered a significantly longer 3-year survival rate than core decompression.CJFH typing was risk factors for failure of the operation in the two groups,while ARCO stage was significant only in core decompression group.Conclusions:Both impacted bone grafting and core decompression combined with autologous bone marrow stem cell grafting are effective methods in treating ARCOⅡnon-traumatic ONFH.However,for patients belonging to CJFH type L2,L3 or ARCO stageⅡC,impacted bone grafting offers significantly better outcomes.The degree of the lateral pillar involved of CJFH typing is a risk factor for failure of operation,while the necrosis size only affects the prognosis of core decompression group but has no effect on impacted bone grafting group.

关 键 词：股骨头坏死 髓芯减压 打压植骨 ARCO分期 中日友好医院分型 

分 类 号：R687.3[医药卫生—骨科学]