磷酸钙骨水泥/丹参缓释系统植入治疗股骨头缺血性坏死  

IMPLANTATION OF CALCIUM PHOSPHATE CEMENT/DANSHEN DRUG DELIVERY SYSTEM FOR AVASCULAR NECROSIS OF FEMORAL HEAD

作　　者：黄相杰[1] 姜红江[1] 刘德忠[1] 周志高[1] 王亮[1] 

机构地区：[1]文登整骨医院骨关节治疗中心,山东文登264400

出　　处：《中国修复重建外科杂志》2008年第3期307-310,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家中医药管理局中医药科学技术研究专项资助(02-03LP33)~~

摘　　要：目的探讨应用磷酸钙骨水泥/丹参缓释系统治疗早、中期股骨头缺血性坏死的效果。方法 2000 年5月-2005年6月,对48例(54髋)股骨头缺血性坏死患者行病灶清除、磷酸钙骨水泥/丹参缓释系统植入治疗。男32例(36髋),女16例(18髋);年龄26～62岁,平均38.7岁。有烟酒史21例,接受激素治疗史15例,髋关节轻微扭伤史2 例,余患者无明显诱因。病程2～32个月。按世界骨循环研究学会国际骨坏死分期标准,Ⅰ期9髋,Ⅱ期31髋,Ⅲ期14髋。采用95丹东成人股骨头缺血性坏死疗效评价标准进行评分,Ⅰ期患者平均76.94分,Ⅱ期平均62.38分,Ⅲ期平均55.64分。均经X线、CT或MRI检查,证实为股骨头缺血性坏死。术后随访观察疗效。结果患者术后均未发生下肢深静脉血栓、异物排斥反应等并发症,切口Ⅰ期愈合。48例均获随访22～73个月,平均42.5个月。采用上述疗效评价标准进行评分,Ⅰ期患者平均96.89分,Ⅱ期平均92.54分,Ⅲ期平均78.46分。优33髋,良17髋,可3髋,差1髋,优良率为92.6%。结论磷酸钙骨水泥/丹参缓释系统植入治疗股骨头缺血性坏死,在髓芯减压、死骨清除的基础上,提供了骨修复的力学支撑,避免了股骨头塌陷,同时通过中药的局部释放改善股骨头微循环,有利于股骨头的修复重建,手术创伤小、操作简便,适合于治疗早、中期股骨头缺血性坏死患者。Objective To introduce a new method using calcium phosphate cement/Danshen drug delivery system for avascular necrosis of femoral head and to evaluate its clinical outcome. Methods From May 2000 to June 2005, 48 patients （54 hi ps） with avascular necrosis of femoral head were treated with calcium phosphate cement/Danshen drug delivery system implantation in the involved femoral head. There were 32 males（36 hips） and 16 females（18 hips） with an average age of 38.7 years （26-62 years）. Twenty-one cases had the history of drinking or smoking, 15 cases had the history of receiving hormonotherapy and 2 had the history of injury in hip joint. The disease course was 2-32 months. According to standard of Association Research Circulation Osseous （ARCO） staging, 9 hips were classified as stage Ⅰ, 31 as stage Ⅱ and 14 as stage Ⅲ. The operation consisted of removal of necrotic bone under weight-loading cartilage and the implantation of calcium phosphate cement/Danshen drug delivery system, all manipulations were done through a bone tunnel in trochanter. The function of hip joint were evaluated and X-ray films were taken pre- and post-operatively. Results No phlebothrombosis of leg and foreign body action occurred in all cases, and incision healed by first intention. The postoperative follow-up averaged 42.5 months, ranging from 22 to 73 months. According to the evaluation criterion of Dandong 1995 for adult avascular necrosis of femoral head, the results were excellent in 33 hips, good in 17, fair in 3 and poor in 1, the excellent and good rate was 92.6 %. Conclusion This method is relatively simple with less invasion, it not only improves the microcirculation of femoral head by local application of traditional Chinese medicine, but also provide mechanic buttress in the weight-loaded area, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimally invasion surgery for femoral head necrosis.

关 键 词：磷酸钙骨水泥 丹参 药物缓释系统 股骨头缺血性坏死 

分 类 号：R687.3[医药卫生—骨科学]