同种异体骨打压植骨治疗股骨头缺血性坏死的疗效观察  

Observation on the efficiency of allogeneic bone impaction grafting in the treatment of osteonecrosis of the femoral head

作　　者：孙大铭[1] 张洪[1] 张伟佳[1] 章亚东[1] 马云青[1] 

机构地区：[1]解放军总医院第一附属医院骨科研究所,北京100048

出　　处：《中国骨与关节杂志》2012年第5期454-457,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨同种异体骨打压植骨治疗股骨头缺血性坏死的效果。方法 2010年5月至2011年12月,收治17例股骨头缺血性坏死的患者。年龄25～50岁,平均年龄34岁,男11例13髋,女6例7髋左侧5例,右侧9例,双侧3例。按照国际骨循环研究学会(ARCO)分期,Ⅰ期5例6髋、Ⅱ期12例14髋。同种异体骨取自25～40岁健康人群,异体骨经过深低温冷冻处理手术采用经股骨颈通道去除坏死组织许打压植入同种异体骨碎块。同种异体骨取自健康人群,异体骨经过深低温冷冻处理。术前及术后随访行X线平片及MRI检查。术前,术后及随访时采用进行Harris评分对髋关节功能进行评价,随访时间为6个月至2年,平均为13.5个月。采用SPSS17.0统计学软件进行数据分析。结果术后1例2髋患者疼痛无明显缓解,其余患者的髋关节疼痛获得缓解。术前Harris评分为(74.0±6.2)分,最后一次随访的Harris评分平均为(89.4±7.6)分随访结果优11髋,良5髋,优良率为89.4%。术后X线片冠示,减压植骨的通道内成骨现象日渐明显,3-6个月现新生骨柱影。1例双髋患者出现股骨头塌陷,行全髋置换术。1例出现排异反应。结论同种异体骨打压植骨移植适于治疗无塌陷的早期股骨头坏死,远期效果尚需进一步观察和研究。Objective To investigate the efficiency of allogeneic bone impaction grafting in the treatment of osteonecrosis of the femoral head （ONFH）. Methods From May 2010 to December 2011, 17 patients who were diagnosed as ONFH were adopted. There were 11 males （13 hips） and 6 females （7 hips）, whose mean age was 34 years old （range; 25-50 years）. Among them, the left side was involved in 5 cases, the right side in 9 cases and bilateral sides in 3 cases. According to Association of Research Circulation Osseous （ARCO） classification system, 5 cases （6 hips） were classified as ARCO stage Ⅰ and 12 cases （14 hips） as stage Ⅱ. The allogeneic bone was donated by healthy people aging from 25 to 40 years old, and it was processed under deep frozen condition. Firstly, the necrotic tissue was removed through a channel in the femoral neck, and then the allogeneic bones were impacted and implanted. The allogeneic fresh-frozen bone was all from the healthy group. X-ray and MRI examinations were performed preoperatively, postoperatively and during the follow-up. The Harris score was used to evaluate the hip function preoperatively, postoperatively and during the follow-up. The patients were followed up for a mean period of 13.5 months （range; 6 months to 2 years）. The data was analyzed with SPSS Statistics 17.0. Results Postoperatively 1 patient （2 hips） did not get obvious pain relief, and the other patients all got hip pain relief. The preoperative mean Harris score was 74.0±6.2 points, and it increased to 89.4±7.6 points in the latest follow-up. The follow-up results showed that there were 11 excellent hips and 5 good hips, and the excellent and good rate was 89.4%. Postoperative X-ray showed more and more new bone formed in the decompression and bone grafting channel day by day, and new bone column images appeared after 3-6 months. Total hip arthroplasty was performed on 1 patient with ONFH in bilateral hips due to the collapse of the femoral head. Reject reaction occurred in 1 patient. C

关 键 词：股骨头坏死 打压植骨 同种异体骨 髓芯减压 

分 类 号：R687.3[医药卫生—骨科学]