人工骨棒结合混合PRP的自体髂骨联合减压术治疗早期股骨头坏死  

Treatment of Early Femoral Head Avascular Necrosis by Core Decompression Combined with Artificial Bone Support Rods and Autologous Iliac Bone Mixed with PRP

作　　者：王玥 贾其余 曹溢 刘先哲[2] Wang Yue;Jia Qiyu;Cao Yi(Department of Orthopedics,The Second People＇s Hospital of Hefei City,Hefei 230032,China)

机构地区：[1]安徽医科大学附属合肥医院合肥市第二人民医院骨科,安徽合肥230032 [2]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022

出　　处：《实用骨科杂志》2018年第10期885-889,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨纳米晶胶原基人工骨支撑架结合植入混合PRP的自体髂骨,治疗成人早期股骨头坏死的疗效。方法回顾性分析2015年8月至2017年1月,我院利用髓芯减压联合纳米晶胶原基人工骨支撑棒结合植入混合PRP的自体髂骨治疗19例(20髋)早期股骨坏死(SteinbergⅠ~Ⅱ期)患者的临床效果,其中男14例,女5例;年龄为29~55岁,平均(36.2±8.6)岁;单侧18例,双侧1例。观察术后骨坏死进展及股骨头塌陷情况,采用Harris髋关节评分系统评定手术治疗股骨头坏死的效果。影像学评估主要是通过拍摄髋关节X线片,评估患者术后1、6、12个月的股骨头有无坏死及修复情况。结果所有患者术后随访12个月,均在术后12个月行Harris评分。Harris评分术前平均(63.6±11.6)分,术后提高至(89.5±10.3)分,提高分数平均(25.9±11.2)分,差异有统计学意义(P<0.05)。本组20髋病例中,优14髋,良3髋,可2髋,差1髋,优良率达85%。其中1例患者术后12个月仍有髋部疼痛。X线片显示有3例髋关节表现出影像学进展,患者的临床症状、体征改变与影像学进展变化相一致。结论髓芯减压联合纳米晶胶原基人工骨支撑棒结合植入混合PRP的自体髂骨治疗早期股骨头坏死的手术方法,适用于中青年股骨头无菌性坏死患者,对于缓解患者髋关节疼痛症状、恢复髋关节功能、防止股骨头塌陷、推迟患者髋关节置换有着重要意义。Objective To investigate the efficacy of nanocrystalline collagen-based artificial bone support combined with allogeneic bone grafting in the treatment of early femoral head necrosis in adults. Methods From August 2015 to January 2017,19 patients with early femoral head necrosis （Steinberg stage I~Ⅱ） were treated with core decompression combined with nanocrystalline collagen-based artificial bone support rods and autologous iliac bone implanted with PRP in our hospital,including 18 cases on one side and 1 case on both sides.There were 14 males and 5 females.The progress of osteonecrosis and the collapse of the femoral head were observed.Comparing the changes of Harris hip score before and after surgery.The radiographic evaluations were performed at 1,6,12 months postoperatively with pelvic radiographs,to observe the femoral head repair and necrosis. Results All patients were followed up for 12 months after surgery.Harris scores were performed 12 months postoperatively.The statistical results showed that there was a significant difference between preoperative and postoperative Harris scores.According to the Harris scoring system,there were 14 excellent hips,3 good hips,2 not bad hips,and 1 poor hip,in this group of 20 hips.The excellent and good rate was 85%.One patient still had hip pain after surgery.The results of radiographs showed that 3 hips showed imaging progress,and imaging changes were consistent with clinical symptoms and signs of patients. Conclusion Core decompression combined with nanocrystalline collagen-based artificial bone support rods and autologous iliacbone implanted with PRP for the treatment of early femoral head necrosis is suitable for young patients with femoral head necrosis,which is of great significance for relieving hip joint pain,restoring joint function and postponing total hip arthroplasty.

关 键 词：股骨头缺血性坏死 人工骨支撑棒 富含血小板血浆 

分 类 号：R687.4[医药卫生—骨科学]