偏心钻减压后注射型硫酸钙植入治疗早期股骨头坏死  

Treatment of early-stage femoral head necrosis with calcium sulfate-based bone graft injection after decompression with off-center drill

作　　者：王志刚[1] 魏民[1] 刘玉杰[1] 李众利[1] 朱娟丽[1] 刘洋[1] 李佳[1] 吴兵[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《军医进修学院学报》2011年第8期788-790,共3页Academic Journal of Pla Postgraduate Medical School

基　　金：解放军总医院苗圃基金(08MP07)

摘　　要：目的探讨采用偏心钻减压后植入注射型硫酸钙治疗早期股骨头坏死的疗效。方法 2005年3月-2009年1月应用自制偏心钻清除股骨头坏死骨后,植入注射型硫酸钙治疗早期股骨头缺血性坏死28例,其中男性24例,女性4例;年龄35.6(21-57)岁。在G型臂透视下采用2.4mm克氏针钻入股骨头坏死区中心,沿导针钻入空心钻,然后置入偏心钻,在关节镜监视下去除死骨,最后注入注射型硫酸钙。结果术后随访24例,随访时间12-52个月,平均38个月;术前Harris评分52-74分,平均62.5分,术后68-93分(平均84.5分),平均增加22分。疗效标准按Harris评估,本组优良18例(75%),中5例(20.8%);差1例(4.17%)。结论关节镜监视下应用偏心钻去除股骨头坏死骨后,植入注射型硫酸钙能有效起到支撑作用并预防股骨头塌陷,疗效满意。Objective To study the clinical effect of calcium sulfate–based bone graft injection and core decompression on early-stage femoral head necrosis.Methods From March 2005 to January 2009,28 patients（24 males and 4 females） with early-stage femoral head necrosis at an average age of 35.7（21-57） years were treated with calcium sulfate–based bone graft injection and core decompression by off-center drill.A 2.5mm K-wire was inserted from the proximal lateral femoral cortex into the center of femoral head necrosis under the guidance of G-arm imaging.Then a core reamer and an off-center drill were inserted in the guide pin.The necrotic bone and its margins were completely removed under an arthroscope.Calcium sulfate–based bone graft injection was injected into the bone channel and cavity.Results Twenty-four patients were followed up for an average period of 38 months（12-52 months）.The outcome was evaluated by Harris score.The mean preoperative Harris hip score was 62.5（52-74）,and increased to 84.5（63-93） after operation.According to the Harris hip score,the results were excellent or good in 18 patients（75%）,fair in 5 patients（20.8%）,and poor in 1 patient（4.2%）,respectively.Conclusion Calcium sulfate–based bone graft injection after core decompression with off-center drill plays a supportive role in preventing collapse of femoral head with satisfactory results.

关 键 词：股骨头坏死 髓心减压 偏心钻 注射型硫酸钙 

分 类 号：R681[医药卫生—骨科学]