经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨治疗股骨头坏死的疗效及安全性分析  

Efficacy and Safety Analysis of Core Decompression Using Percutaneous Expandable Reamer Combined with PRO-DENSE Renewable Bone Grafting for the Treatment of Femoral Head Necrosis

作　　者：郝志鹏 吴涛 李晓华 刘永强 HAO Zhipeng;WU Tao;LI Xiaohua;LIU Yongqiang(Department of Osteology,Shijiazhuang People's Hospital,Shijiazhuang 050011,China)

机构地区：[1]石家庄市人民医院骨科,石家庄050011

出　　处：《临床误诊误治》2024年第6期36-41,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20191465)。

摘　　要：目的探究经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术在股骨头坏死(ONFH)治疗中的应用价值。方法回顾性选取2020年1月1日—2022年1月1日100例ONFH,根据手术方法分为2组各50例。对照组行髓芯减压自体骨植骨术,观察组行经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术。比较2组手术观察指标、手术疗效、并发症发生情况,以及手术前后神经源性炎症指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))]、血清生化指标[缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子A(VEGF-A)、Ⅰ型前胶原氨基酸前肽(PⅠNP)、骨钙素(BGP)]、视觉模拟量表(VAS)评分、Harris髋关节功能评分。结果观察组术中出血量(24.25±4.78)mL少于对照组(50.29±8.94)mL,住院时间(12.50±2.24)d短于对照组(15.12±3.37)d(P<0.01)。观察组术后1、3及7 d血清NGF、PGE_(2)低于对照组(P<0.05)。观察组术后1、3及6个月血清HIF-1α、VEGF-A、BGP及Harris髋关节功能评分较对照组高,血清PⅠNP及VAS评分较对照组低(P<0.05)。2组手术优良率、并发症总发生率比较,差异无统计学意义(P>0.05)。结论经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术是ONFH患者安全可靠的治疗方式,能降低炎性因子水平,促进术后早期恢复,加速骨代谢,促进髋关节功能恢复,减轻患者疼痛。Objective To explore the application value of core decompression using percutaneous expandable reamer combined with PRO-DENSE renewable bone grafting in the treatment of osteonecrosis of the femoral head(ONFH).Methods A total of 100 patients with ONFH treated from January 1,2020 to January 1,2022 were retrospectively selected and divided into two groups with 50 cases in each group according to the surgical method.The control group underwent core decompression and autogenous bone grafting,and the observation group underwent core decompression using percutaneous expandable reamer combined with PRO-DENSE regenerated bone grafting.Surgical observation indexes,surgical efficacy and complications were compared between the two groups.Neurogenic inflammatory markers[nerve growth factor(NGF),prostaglandin E_(2)(PGE_(2))],serum biochemical markers[hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor A(VEGF-A),procollagen typeⅠN-propeptide(PⅠNP),osteocalcin(BGP)],visual analogue scale(VAS)score and Harris hip function score before and after operation were compared between the two groups.Results The intraoperative blood loss in the observation group[(24.25±4.78)mL]was less than that in the control group[(50.29±8.94)mL],and the length of hospitalization[(12.50±2.24)d]was shorter than that in the control group[15.12±3.37)d](P<0.01).Serum NGF and PGE_(2) in the observation group were lower than those in the control group at 1,3 and 7 d after operation(P<0.05).Serum HIF-1α,VEGF-A,BGP and Harris hip function scores in observation group were higher than those in control group at 1,3 and 6 months after operation,while serum PⅠNP and VAS scores were lower than those in control group(P<0.05).There was no significant difference in the excellent and good rate of operation and total incidence of complications between the two groups(P>0.05).Conclusion Core decompression using percutaneous expandable reamer combined with PRO-DENSE regenerative bone grafting is a safe and reliable treatment for patients with

关 键 词：股骨头坏死 髓芯减压 自体骨植骨 扩张式铰刀 PRO-DENSE可再生骨植骨 神经生长因子 疼痛 血管内皮生长因子A 

分 类 号：R687.3[医药卫生—骨科学]