髓芯减压并非细胞型组织工程骨移植与联合钛棒支撑治疗早期股骨头坏死的比较  

Bouche decompression and transplantation of acellular tissue engineered bone with or without titanium rods in treating early necrosis of the femoral head

作　　者：杨新明[1] 石蔚[1] 杜雅坤[2] 孟宪勇[1] 

机构地区：[1]河北北方学院附属第一医院骨科,河北省张家口市075000 [2]河北省儿童医院,河北省石家庄市050001

出　　处：《中国组织工程研究与临床康复》2009年第30期5881-5886,共6页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：河北省卫生厅<河北省2007年医学科学研究重点课题计划>(07341);河北省张家口市2007年科学技术与发展指令计划(0711045D-5)~~

摘　　要：目的：比较单纯髓芯减压白体红骨髓非细胞型组织工程骨移植，与联合钛棒支撑非细胞型组织工程骨移植治疗早期股骨头坏死的临床疗效。方法：选择2001—01／2007—03河北北方学院附属第一医院骨科收治的早期股骨头坏死患者67例（77髋），男54例，女13例；年龄28-53岁，平均40．6岁：按单双数入院日期随机分2组，对照组35例（41髋，Ⅰ期18髋、Ⅱ期23髋）：采用单纯髓芯减压白体红骨髓非细胞型组织工程复合物移植；治疗组32例（36髋，I期15髋、II期21髋）：采用髓芯减压联合自制钛棒支撑的自体红骨髓非细胞型组织工程复合物移植。术前均行X射线摄片、CT、MRI检查；C型臂X射线透视下行股骨头坏死区和囊性变区定位、髓芯减压，关节镜经髓道监视下，刮除硬化骨送病理；植入由白体红骨髓与骨诱导活性材料复合成的非细胞型组织工程骨，或钛棒支撑股骨头软骨下骨质。患者于治疗后6，12，24个月进行随诊，临床评价包括：疼痛评分，Harris髋关节评分，X射线观察；每组治疗前后比较采用studentt检验，组间比较采用Mann—Whitney U检验。结果：在疼痛评分方面，两组治疗方法均可以减轻疼痛，早期差异不明显，但随着时间的推移，治疗组明显优于对照组；在Harris髋关节评分方面，两组治疗方法均可以改善和提高Harris髋关节评分，治疗组明显优于对照组。在总的临床结果方面，两组治疗方法对股骨头坏死Ⅰ期病变治疗效果相同，治疗组未显示出优势，但对股骨头坏死Ⅱ期病变治疗组在疗效改善及防止股骨头塌陷避免行全髋关节置换方面明显优于对照组。结论：髓芯减压非细胞型组织工程骨植入与联合钛棒支撑对于二早期股骨头坏死的治疗有极好的修复作用，特别对股骨头坏死Ⅱ期病变在改善及防止股骨头塌陷的疗效优于无钛棒支撑的复合物OBJECTIVE： To compare the curative effect of bouche decompression and transplantation of acellutar tissue engineered bone with or without titanium rods in treating early necrosis of the femoral head. METHODS： Totally 67 patients with 77 coxas suffered from early necrosis of the femoral head admitted at the Department of Orthopaedics, the First Affiliated Hospital of Hebei North University were collected, including 54 male and 12 female, aged 28 53 years （mean 40.6 years）. All patients were divided into control and experimental groups according to admitted days （even or odd）. The control group including 35 patients （41 coxas, 18 cases with stage Ⅰ, 23 stage Ⅱ ）, which were received bouche decompression and the transplantation of acellular tissue engineered bone without the use of titanium rods. While the treatment group included 32 patients （36 coxas, 15 cases with stage Ⅰ, 21 with stage Ⅱ ）, and they were treated with the use of titanium rods besides the same method as the control group. X-ray, CT and MRI were performed prior to operation. The area of NFH detection and cystis degeneration location, as well as bouche decompression was performed under X-ray with C-arm. Simultaneously, the necrotic bone was cleared for the pathologic diagnosis under the monitoring of arthroscopy. And then the acellular tissue engineered bone, which was the complex of autologous red bone marrow and osteoinductice absorbing material, was transplanted in the body, meanwhile, the titanium rods were used to pedestal the sclerotin. All the patients were followed up at 6, 12, 24 months after the operation. The estimation of clinical results includes the pain scores, Harris＇ scores and the performance of X-ray. Student t was used to test the results in each group prior to and after operation, and Mann-Whitney U was used between the groups. RESULTS： Both of the methods were able to relieve the pain in early phase, however, the experimental group showed advantage with time increasing. And both of methods could

关 键 词：股骨头坏死 减压 自体红骨髓 非细胞型组织工程 钛棒 

分 类 号：R845.2[医药卫生—航空、航天与航海医学]