灯泡状病灶清除打压植骨术治疗股骨头坏死的疗效  

Treatment of Osteonecrosis of Femoral Head with Lightbulb-shaped Lesion Clearance with Compact Bone Graft

作　　者：冯学涛[1] 孙鲁伟[1] 王景彦[1] 孙伟[2] Feng Xuetao Sun Luwei Wang Jingyan et al(Department of Orthopaedic Surgery,Weifang Traditional Hospital,Weifang,261041 China)

机构地区：[1]潍坊市中医院骨伤科,山东潍坊261041 [2]北京市中日友好医院骨科,北京100029

出　　处：《实用骨科杂志》2016年第10期878-880,897,共4页Journal of Practical Orthopaedics

基　　金：国家自然科学基金面上项目(81372013);中日友好医院青年英才项目(2014-QNYC-A-06)

摘　　要：目的探讨股骨头颈交界开窗灯泡状病灶清除打压植骨术治疗早中期股骨头坏死的初步疗效。方法自2011年5月至2012年9月在潍坊市中医院治疗股骨头坏死患者32例(39髋),随访2年。其中ARCO分期:Ⅱ期29髋、Ⅲa期10髋,行股骨头颈交界开窗灯泡状病灶清除打压植骨术,采用Harris评分系统评估术后患髋关节的功能改善情况,并于3、6、9个月及每年定期予以X线检查,进行影像学评估。结果参考Harris评分系统:优21髋,良9髋,可6髋,差3髋,患者治疗前的Harris评分平均为(70.21±7.36)分,治疗后平均为(85.50±9.87)分,平均提高15.29分(P<0.01)。影像学检查表现稳定,绝大部分病例未出现进一步塌陷,股骨头内成骨明显。结论股骨头颈交界开窗灯泡状病灶清除打压植骨术手术操作微创,不破坏股骨头本身的血液供应,死骨清除彻底,减压充分,植入成骨活性较好的骨质及磷酸三钙多孔生物陶瓷,成骨作用强,并增加了股骨头坏死区软骨下骨的机械支撑,对早中期股骨头坏死有很好的临床疗效。Objective To explore the preliminary efficacy of lightbulb-shaped lesion clearance with compact bone graftin the treatment of femoral head necrosis Methods 32 patients（ 39 hips） of femoral head osteonecrosis were treated with lightbulb-shaped lesion clearance with compact bone graft in Weifang Traditional Hospital from 2011. 05 to 2012. 09,followed up for 2 years. According to the ARCO staging system,there were 29 hips of stage Ⅱ,10 hips of stage Ⅲa. All patients were evaluated both clinically and radiographically at 3,6,9 months post operation and annually. Functional improvement was assessed with the Harris hip score. Results According to the Harris hip score system,there were excellent results in 21 hips,good in69 hips,fair in 6 hips and poor in 3 hips. The mean pre-operative and post-operative Harris scores were（ 70. 21 ± 7. 36） and（ 85. 50 ± 9. 87）,respectively,with a mean improvement of 15. 29 points（ P〈0. 01）. Almost all hips were radiologically stable,with no progress of osteonecrosis,and bone density in the bone graft area increased obviously. Conclusion The lightbulb operation do not damage the blood supply of the femoral head with minimally invasivion,completely clearance and full decompression. Additionally,the porous bioceramic β-tricalcium phosphate which was planted into the femoral head can play a supporting role in the lateral column of the necrotic area. In sum,The lightbulb operation has good curative effect on early and mid stage of the femoral head osteonecrosis.

关 键 词：灯泡状病灶清除打压植骨术 磷酸三钙多孔生物陶瓷 股骨头坏死 疗效 

分 类 号：R681.8[医药卫生—骨科学]