纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗ARCOⅢ期股骨头坏死  

Nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft for the treatment of ARCO stage Ⅲ osteonecrosis of the femoral head

作　　者：岳聚安 郭晓忠 王冉东 李兵 孙强[1] 张启栋[3] 刘忘言 陈蛟 李迎楠 Yue Ju'an;Guo Xiaozhong;Wang Randong;Li Bing;Sun Qiang;Zhang Qidong;Liu Wangyan;Chen Jiao;Li Yingnan(Department of Joint Surgery,Aviation General Hospital,Beijing 100012,China;Department of Orthopedics,Beijing Jishuitan Hospital,Beijing 100096,China;Department of Joint Surgery,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]航空总医院关节外科,北京市100012 [2]积水潭医院矫形骨科,北京市100096 [3]中日友好医院关节科,北京市100029

出　　处：《中国组织工程研究》2020年第28期4485-4491,共7页Chinese Journal of Tissue Engineering Research

基　　金：航空总医院博士专项基金(YJ-202018),项目负责人:岳聚安;国家自然科学基金(81705896),项目负责人:张启栋;国家重点研发项目(2017YFC0108102),项目参与者:岳聚安。

摘　　要：背景:对于股骨头坏死Ⅲ期患者是否进行保头手术治疗,保头手术后临床效果如何,一直存在争议。目的:分析纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗ARCOⅢ股骨头坏死的临床疗效。方法:选择2017年3月至2018年9月航空总医院收治的股骨头坏死患者36例,其中男32例,女4例,年龄16-58岁,双侧坏死3例,单侧坏死33例,按ARCO分期中塌陷程度ⅢA期35髋、ⅢB期3髋、ⅢC期1髋,均接受纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨植入治疗。术后进行随访,采用Harris髋关节评分评价髋关节功能,利用X射线评估股骨头塌陷程度,CT检测评估坏死区成骨情况。研究获得航空总医院伦理委员会批准(伦理编号:HK2019-01-04)。结果与结论:①36例患者获得(19.28±6.51)个月随访,末次随访时4个股骨头保头失败行全髋关节置换术,保头成功率为89.7%(35/39);②Harris髋关节评分显示,36例患者末次随访的髋关节功能优良率明显高于术前(71.8%,17.5%,P=0.000);③末次随访CT图像显示,术前ⅢA期35髋中26髋可见明显成骨迹象;术前ARCOⅢB期3髋均未见明显成骨迹象;术前ARCOⅢC期1髋未见成骨;④末次随访X射线片显示,术前ARCOⅢA期35髋中5髋有进展,其中3髋进展到ⅢB期、2髋进展到Ⅳ期,剩余30髋病情稳定无进展;术前ARCOⅢB期3髋均有进展,其中2髋进展到ⅢC期,1髋进展到Ⅳ期;术前ARCOⅢC期1髋进展到Ⅳ期;⑤结果表明,纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗ARCOⅢ股骨头坏死具有较好的疗效。BACKGROUND: It remains controversial whether patients with ARCO stage Ⅲ osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is. OBJECTⅣE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage Ⅲ osteonecrosis of the femoral head METHODS: From March 2017 to September 2018, 36 patients(32 male and 4 female, 16-58 years old) with ARCO state Ⅲ osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage ⅢA, 3 hips in stage ⅢB, and 1 hip in stage ⅢC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee(Ethics code: HK2019-01-04). RESULTS AND CONCLUSION:(1) Thirty-six patients were followed up for(19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39).(2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery(71.8%,17.5%, P=0.000).(3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage ⅢA and it was observed in neither 3 hips at ARCO stage ⅢB nor in 1 hip at ARCO stage ⅢC.(4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips(ⅢA), 3 of which progressed to ARCO stage

关 键 词：股骨头坏死 激素 酒精 创伤 特发 支撑棒 同种异体骨 骨关节炎 关节置换 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]