强化力学结构治疗股骨头坏死的临床研究  

Biostructural augmentation for the treatment of osteonecrosis using the insertion of hollow bone screw incorporated with autogenous bone graft

作　　者：杨述华[1] 杨操[1] 李宝兴[2] 邵增务[1] 孙世荃[2] 许伟华[1] 李进[1] 肖宝钧[1] 叶哲伟[1] 傅德皓[1] 苏成忠[2] 王锐英[1] 梅荣成[1] 

机构地区：[1]武汉华中科技大学同济医学院附属协和医院骨科,湖北430022 [2]中国辐射防护研究院山西省医用组织库

出　　处：《中华骨科杂志》2006年第5期313-316,共4页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助项目(30170945;30471753)

摘　　要：目的探讨髓芯减压术后利用空心骨螺钉结合自体骨移植强化股骨头力学结构,治疗早期股骨头坏死的疗效。方法自2000年2月至2005年2月,共收治股骨头坏死塌陷前期患者31例,其中FicatⅠ期18例,Ⅱ期13例。男18例,女13例;年龄27～49岁,平均37岁。2例为双侧,其余为单侧。发病至手术时间为6￣26个月。多数患者术前曾行6个月以上的非手术治疗,但疗效不佳。自转子下经股骨颈钻隧道至股骨头坏死区域,行髓芯减压术后,取自体髂骨装入空心骨螺钉内并植入股骨头坏死区的隧道内,隧道远端用含脱钙骨基质(decalcifiedbonematrix,DBM)的生物材料填充。患者术后1～2周使用助步器下床活动,6周后根据恢复情况增加负重,10周时可扶拐行走。结果所有病例术后随访1～5年,平均2.8年。髋关节Harris评分,优21例,疼痛消失,不需服用镇痛药;良8例,明显减轻,偶尔服用镇痛药;可2例,有改善,可正常行走或稍有跛行,但需经常服用镇痛药。Harris髋关节评分由术前的76分提高到术后的91分。结论采用空心骨螺钉结合自体骨移植治疗塌陷前期(FicatⅠ～Ⅱ期)的股骨头坏死效果满意,中、远期疗效有待进一步观察。Objective To evaluate the result of biostructural augmentation for the treatment of osteonecrosis through a modified core decompression procedure combined with the insertion of hollow bone screws incorporate with autogenous bone graft. Methods From Feb. 2002 to Feb. 2005, 31 cases （33 hips） with femoral head necrosis were treated using insertion of hollow bone screw incorporates with autogenous bone graft in our hospital. There were 18 males, 13 females, with an average of 37 years （range from 27 to 49 years）, which included Ficat Ⅰ stage 18 cases, Ⅱ stage 13 cases. A 9 mm trephine was introduced manually under fluoroscopic control through the greater trochanter into the necrotic lesion. The tip of the trephine was placed at a distance of 5 mm from the articular cartilage. After cleaning up necrotic bone of the femoral head, hollow bone screw incorporated with autogenous bone graft was inserted through trochanter tunnel to zone of femoral head necrosis. The distal tunnel was filled with biomaterial containing decalcified bone matrix （DBM）. Results All cases obtained satisfaction effect especially a significant reduction in pain in average 2.8 years follow-up. Harris score increased from 76 preoperation to 91 postoperation. Conclusion Biostructural augmentation for the treatment of osteonecrosis using the insertion of hollow bone screws incorporated with autogenous bone graft is an effective method for femoral head necrosis of Ficat Ⅰ - Ⅱ stage. But further study is needed to confirm mid- and long-term result.

关 键 词：股骨头坏死 减压 骨移植 移植 自体 骨钉 

分 类 号：R681.8[医药卫生—骨科学]