关节镜监视下髓芯减压加自体骨打压植骨联合纳米仿生骨修复材料支撑治疗早期股骨头坏死的疗效分析  

Treatment of Early Osteonecrosis of the Femoral Head with Arthroscopic Monitoring of Core Decompression and Bone Grafting Combined with Nanomimetic Bone Scaffold

作　　者：程省[1] 叶向阳[1] 汤立新[1] 王华磊[1] 马远[1] 赵玉果[1] CHENG Sheng;YE Xiangyang;TANG Lixin;WANG Hualei;MA Yuan;ZHAO Yuguo(Department of Orthopaedics,Nanyang Central Hospital,Nanyang Henan 473005 China)

机构地区：[1]南阳市中心医院骨科,河南南阳473005

出　　处：《华南国防医学杂志》2020年第10期695-698,共4页Military Medical Journal of South China

基　　金：2018年河南省重点研发与推广专项(182102310466)。

摘　　要：目的探讨关节镜监视下髓芯减压加自体骨打压植骨联合纳米仿生骨修复材料支撑治疗早期股骨头坏死(osteonecrosis of the femoral head,OFH)的临床疗效。方法回顾性分析作者医院骨科2016-01/2019-01月利用关节镜监视下髓芯减压加自体骨打压植骨联合纳米仿生骨修复材料支撑治疗的15例(18髋)早期OFH患者资料,其中男9例,女6例,年龄21~40(32±5.67)岁。致病原因:激素性9例(11髋),酒精性3例(4髋),创伤性2例(2髋),不明原因1例(1髋)。按照OFH国际骨循环研究会(association research circulation osseuse,ARCO)分型标准,ARCOⅠ期5髋,ACROⅡ期10髋,ARCOⅢ期3髋。所有患者均由同一组医生完成手术。对比患者术前与末次随访的VAS评分及Harris评分,记录患者术中与随访中的并发症情况,对患者疗效进行评价。结果所有患者均获得12个月以上随访,随访时长12~30(18±4.32)个月。所有患者手术切口均Ⅰ期愈合,无伤口感染、血管神经损伤、关节软骨损伤及手术材料排斥等并发症发生。患者术前与末次随访VAS评分比较,差异有统计学意义(4.11±1.02 vs.1.06±0.80;t=9.970,P=0.000)。患者术前与末次随访Harris髋关节评分比较,差异具有统计学意义(61.00±7.88 vs.85.17±5.22;t=11.660,P=0.000),末次随访Harris髋关节评分优良率(优:5例,良:10例,可:3例,差:0例)为83.33%。结论关节镜监视下髓芯减压加自体骨打压植骨联合纳米仿生骨修复材料支撑治疗早期OFH安全有效,能明显减轻患者髋关节疼痛,改善髋关节功能,防止股骨头塌陷。Objective To investigate the clinical effect of arthroscopic treatment on early osteonecrosis of the femoral head(OFH)by using core decompression and bone graft combined with nano-mimetic bone scaffold.Methods The data of 15 patients with early OFH(18 hips)treated with core decompression and bone graft combined with nano-mimetic bone scaffold were retrospectively analyzed in orthopedics department of author′s hospital from January 2016 to January 2019.There were 9 males and 6 females,aged 21-40(mean 32±5.67)years old.Pathogenic causes:9 cases of hormonal(11 hips),3 cases of alcohol(4 hips),2 cases of traumatic(2 hips),and 1 case of unknown cause(1 hip).According to OFH international association research circulation osseuse(ARCO)classification,5 hips were at ARCO stage I,10 hips were at ACRO stageⅡ,and 3 hips were at ARCO stageⅢ.All patients were treated by the same medical group.The VAS scores and Harris scores of the patients were compared before and after the last follow-up,and the complications during the follow-up were recorded to evaluate the efficacy of the patients.Results All patients were followed up for 12-30(mean 18±4.32)months.All surgical incisions in all patients underwent stageⅠhealing.No complications such as wound infection,vascular and nerve injury,articular cartilage injury and surgical material rejection were observed.The preoperative VAS score was significantly different with the last follow-up VAS score(4.11±1.02 vs.1.06±0.80;t=9.97,P=0.000).The preoperative hip Harris score was significantly different with the last follow-up hip Harris score(61.00±7.88 vs.85.17±5.22;t=11.66,P=0.000).The excellent and good rate(excellent in 5 cases,good in 10 cases,can in 3 cases,poor in 0 case)was 83.33%.Conclusion It is safe and effective to treat early OFH with the application of arthroscopic of core decompression and bone graft combined with nano-mimetic bone scaffold.It can significantly decrease hip pain,improve hip function,and prevent the collapse of the femoral head in patients with ea

关 键 词：关节镜 髓芯减压 纳米仿生骨 股骨头坏死 

分 类 号：R681[医药卫生—骨科学]