同种异体皮质骨支撑骨笼联合自体骨移植治疗股骨头坏死  

ALLOGENEIC CORTICAL BONE CAGE SUPPORT COMBINING WITH AUTOLOGOUS CANCELLOUS BONE GRAFTING FOR MANAGING FEMORAL HEAD NECROSIS

作　　者：许伟华[1] 杨述华[1] 李宝兴[2] 杨操[1] 叶树楠[1] 唐欣[1] 叶哲伟[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022 [2]山西省医用组织库

出　　处：《中国修复重建外科杂志》2009年第5期527-529,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的研究股骨头坏死行开髓减压后,采用同种异体皮质骨支撑骨笼联合自体松质骨移植治疗早期股骨头坏死的临床疗效,探讨其防止股骨头塌陷的作用及影响因素。方法2002年1月-2005年12月,采用同种异体皮质骨支撑骨笼联合自体松质骨移植治疗股骨头坏死40例(42髋)。男26例,女14例;年龄27～45岁,平均35.6岁。病程6～28个月,平均18.3个月。致病原因:特发性9例(9髋),激素性26例(28髋),酒精性4例(4髋),化疗相关性1例(1髋)。术前行正侧位X线、MRI及CT检查,证实为股骨头坏死,确定骨坏死区域和范围。Ficat分期:Ⅰ期12髋,Ⅱ期29髋,Ⅲ期1髋。Harris评分为(63.1±6.4)分。术后定期摄X线片,采用Harris评分评估术后患髋功能改善情况。结果术后切口均Ⅰ期愈合,未发生伤口感染、骨折、神经、血管损伤和深部血管栓塞等并发症。术后36例(38髋)获随访,随访时间24～58个月,平均38个月。患者临床症状均有不同程度改善。术后24个月X线片示23例(24髋)股骨头死骨边缘或中心吸收、缩小,病灶区域再骨化充分,股骨头修复、无坏死塌陷进展。末次随访时Harris评分为(82.3±16.5)分,较术前提高(19.2±14.7)分,比较差异有统计学意义(P<0.001)。根据Harris评分,优24髋,良11髋,可2髋,差1髋。结论同种异体皮质骨支撑骨笼联合自体松质骨移植手术损伤小,适合治疗早期股骨头坏死的年轻患者,近中期疗效满意,并能有效防止股骨头塌陷。Objective To investigate clinical therapeutic e ect on early stage femoral head necrosis managed with allogeneic cortical bone cage support combining with autologous cancellous bone grafting through core decompression tunnel, and to discuss its e ect on preventing femoral head collapse and in uence factors.Methods From January 2002 to December 2005, 40 patients（42 hips） with femoral head necrosis underwent core decompression and an allogeneic threaded cortical bone supporting cage which was loaded with autologous cancellous bone inside.There were 26 males and 14 females, aging 27-45 years（mean 35.6 years）.The disease course was 6-28 months（mean 18.3 months）.All the cases underwent X-ray, CT and MRI examination to con rm the diagnosis and necrosis area.Twelve hips were at Ficat stage I, 29 hip at stage II, and 1 hips at stage Ⅲ.Harris hip score system was used to evaluate the hip function pre-and post-operatively.X-ray lms were taken regularly after operation.Results All the wound healed by rst intention without any complications such as infection, fracture, nerve and vascular injury, and deep vein thrombosis.Thirty-six patients（38 hips） were followed up for 24-58 months with an average of 38 months.All the patients had di erent degrees of improvement in clinical symptoms.According to Harris hip score system, the Harris score was 63.1 ± 6.4 before operation and 82.3 ± 16.5 at the last follow-up, showing signi cant di erence（P 〈 0.001）.The results were excellent in 24 hips, good in 11 hips, fair in 2 hips and poor in 1 hips.The X-ray lms showed femoral head repairing and no advancement of osteonecrosis and collapsing in 23 patients（24 hips） 24 months after operation.Conclusion Allogeneic cortical bone cage support combining with autologous cancellous bone grafting is suitable for managing early stage femoral head necrosis and its short-and middle-term e ect is satisfactory.

关 键 词：股骨头坏死 同种异体骨移植 自体骨移植 修复 

分 类 号：R687.3[医药卫生—骨科学]