粗通道髓芯减压术联合骨诱导活性材料治疗早期股骨头坏死的中期疗效分析
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摘要
背景与目的
股骨头坏死是骨科常见疾病,早期的发现和治疗非常重要,通过及时减压手术干预,进行有意义的保头手术治疗,不仅能够缓解患者的疼痛症状,而且有望保持股骨头的解剖学形态,防止股骨头的塌陷,从而减少因病致残,提高患者生活质量。髓芯减压术正是在临床上广泛应用治疗早期股骨头坏死的减压手术之一,是临床上常用的保头手术,手术操作相对简单,该手术在短期随访中,获得了很好的效果,但是国内外很少有专家学者对该手术的中期疗效进行随访研究。本文通过对此种手术的随访研究,分析粗通道髓芯减压术治疗早期股骨头坏死的中期临床疗效。
方法
采用粗通道髓芯减压术治疗早期股骨头坏死的患者46例56髋,其中男32例,女14例,平均年龄32.6(20-53)岁。按病因分类：酒精性股骨头坏死30例36髋,激素性股骨头坏死11例13髋,激素+酒精性股骨头坏死5例7髋。按照国际骨循环研究学会(ARCO)分期,Ⅰ-A、Ⅰ-B、Ⅰ-C、Ⅱ-A期分别为26、13、8、9髋。左侧43髋,右侧13髋。参照成人股骨头缺血坏死疗效评价标准,从临床和X线两方面对患者的术后恢复情况进行评估,同样对患者术前术后进行疗效评价比较,对不同分期进行粗通道髓芯减压术后疗效进行比较。
结果术后本组患者髋关节疼痛症状均缓解或消失。随访5-7.3年,平均6.1年,未次结果显示：优44髋,良7髋。其中,Ⅰ-A期26髋、Ⅰ-B期13髋均为优,Ⅰ-C期8髋中优2髋、良3髋、可2髋、差1髋；Ⅱ-A期9髋中优3髋、良4髋、可2髋、差0髋。Ⅰ-A、Ⅰ-B、Ⅰ-C、Ⅱ-A期的优良率分别为100%(26/26)、100%(13/13)、62.5%(5/8)、77.8%(7/9),总优良率为91.1%,总有效率为98.2%。其中,Ⅰ-A、Ⅰ-B期的效果最好,X线片显示,减压的粗通道内可见密度增高的骨柱影,股骨头均未塌陷。Ⅰ-C期中效差的1例,其坏死面积太大,达股骨头面积的60%,在术后5年时出现了股骨头塌陷。
结论
粗通道髓芯减压术联合骨诱导活性材料治疗早期股骨头坏死的中期疗效良好,尤以ARCO Ⅰ-A、Ⅰ-B期者为佳。
Background and Purpose
Osteonecrosis of femoral head is a common orthopedic disease, early detection and treatment is very important. A timely surgical intervention to drop intramedullary pressure is very meaningful for the head protection. This could not only relieve the patients from pain symptoms, but also help maintain the anatomical morphology of femoral head, and prevent collapse of the femoral head, help reduce disability caused by the illness, finally help improve the quality life of the patients. Core-decompression surgery is widely used in the clinical treatment of early osteonecrosis of femoral head. The operation is a simple way to gain a relatively good effect, during short-term follow-ups. However at home and abroad there were few researchers and scholars that have done the mid-term efficacy of surgical follow-up studies. The purpose of our study is to analyze the middle-term effects of marrow core compression with thick passage on early osteonecrosis of femoral head(ONFH), based on follow-up of the patients recovered this kind of surgery,
Methods
We studied a total of46adult patients with56hips which suffered from the early stage ONFH and underwent the surgery of marrow core decompression with thick passage. There were32male cases,14female cases, the mean age was32.6(20～53) years old. According to the etiology classification:30patients with36hips were the alcohol-induced ONFH,11patients with13hips were sterorid-induced ONFH in,5patients with7hips were steroid and alcohol-induced ONFH. According to association research circulation osseous (ARCO) classifying,26,13,8,9hips were in stage Ⅰ-A,Ⅰ-B, Ⅰ-C,and Ⅱ-A, respectively. There were43hips in left side and13hips in the right side.
Results
The pain of the hips in all patients was relieved or disappeared after the operation. The period of postoperative follow-up studied from (5-7.3)years, with an average of6.1years. The results showed44hips got excellent effect and7hips got good effect. Of them, all hips in stage Ⅰ-A(26hips) were excellent, and so did all hips in Ⅰ-B(13hips).There were2excellent hips,3good hips,2fair hips and1poor hips in stage Ⅰ-C. In the Ⅱ-A stage there were3hips occured in excellent stage,4hips in good,2hips in fair and0hips in poor. The rate of excellent and good results was100%(26/26),100%(13/13),62.5%(5/8),77.8%(7/9) in stage Ⅰ-A,Ⅰ-B,Ⅰ-C,Ⅱ-A. The total rate of excellent and good results was91.1%, The total efficiency percentage was98.2%,The best results occured in the stage Ⅰ-A and stage Ⅰ-B. The X-ray films showed obviously in this excellent hips, there was bone pillar shadow formed in the thick passage day by day, the femoral head was not collapsed. The1poor hip in stage Ⅰ-C, the necrotic area was up to60%, the femoral head collapsed in five years
Conclusions
The middle-term effects of marrow core compression with thick passage bone grafting with osteoinduction active material are satisfactory，specially in ARCO Ⅰ-A, Ⅰ-B stage patients.
股骨头坏死是骨科常见疾病,早期的发现和治疗非常重要,通过及时减压手术干预,进行有意义的保头手术治疗,不仅能够缓解患者的疼痛症状,而且有望保持股骨头的解剖学形态,防止股骨头的塌陷,从而减少因病致残,提高患者生活质量。髓芯减压术正是在临床上广泛应用治疗早期股骨头坏死的减压手术之一,是临床上常用的保头手术,手术操作相对简单,该手术在短期随访中,获得了很好的效果,但是国内外很少有专家学者对该手术的中期疗效进行随访研究。本文通过对此种手术的随访研究,分析粗通道髓芯减压术治疗早期股骨头坏死的中期临床疗效。
方法
采用粗通道髓芯减压术治疗早期股骨头坏死的患者46例56髋,其中男32例,女14例,平均年龄32.6(20-53)岁。按病因分类：酒精性股骨头坏死30例36髋,激素性股骨头坏死11例13髋,激素+酒精性股骨头坏死5例7髋。按照国际骨循环研究学会(ARCO)分期,Ⅰ-A、Ⅰ-B、Ⅰ-C、Ⅱ-A期分别为26、13、8、9髋。左侧43髋,右侧13髋。参照成人股骨头缺血坏死疗效评价标准,从临床和X线两方面对患者的术后恢复情况进行评估,同样对患者术前术后进行疗效评价比较,对不同分期进行粗通道髓芯减压术后疗效进行比较。
结果术后本组患者髋关节疼痛症状均缓解或消失。随访5-7.3年,平均6.1年,未次结果显示：优44髋,良7髋。其中,Ⅰ-A期26髋、Ⅰ-B期13髋均为优,Ⅰ-C期8髋中优2髋、良3髋、可2髋、差1髋；Ⅱ-A期9髋中优3髋、良4髋、可2髋、差0髋。Ⅰ-A、Ⅰ-B、Ⅰ-C、Ⅱ-A期的优良率分别为100%(26/26)、100%(13/13)、62.5%(5/8)、77.8%(7/9),总优良率为91.1%,总有效率为98.2%。其中,Ⅰ-A、Ⅰ-B期的效果最好,X线片显示,减压的粗通道内可见密度增高的骨柱影,股骨头均未塌陷。Ⅰ-C期中效差的1例,其坏死面积太大,达股骨头面积的60%,在术后5年时出现了股骨头塌陷。
结论
粗通道髓芯减压术联合骨诱导活性材料治疗早期股骨头坏死的中期疗效良好,尤以ARCO Ⅰ-A、Ⅰ-B期者为佳。
Background and Purpose
Osteonecrosis of femoral head is a common orthopedic disease, early detection and treatment is very important. A timely surgical intervention to drop intramedullary pressure is very meaningful for the head protection. This could not only relieve the patients from pain symptoms, but also help maintain the anatomical morphology of femoral head, and prevent collapse of the femoral head, help reduce disability caused by the illness, finally help improve the quality life of the patients. Core-decompression surgery is widely used in the clinical treatment of early osteonecrosis of femoral head. The operation is a simple way to gain a relatively good effect, during short-term follow-ups. However at home and abroad there were few researchers and scholars that have done the mid-term efficacy of surgical follow-up studies. The purpose of our study is to analyze the middle-term effects of marrow core compression with thick passage on early osteonecrosis of femoral head(ONFH), based on follow-up of the patients recovered this kind of surgery,
Methods
We studied a total of46adult patients with56hips which suffered from the early stage ONFH and underwent the surgery of marrow core decompression with thick passage. There were32male cases,14female cases, the mean age was32.6(20～53) years old. According to the etiology classification:30patients with36hips were the alcohol-induced ONFH,11patients with13hips were sterorid-induced ONFH in,5patients with7hips were steroid and alcohol-induced ONFH. According to association research circulation osseous (ARCO) classifying,26,13,8,9hips were in stage Ⅰ-A,Ⅰ-B, Ⅰ-C,and Ⅱ-A, respectively. There were43hips in left side and13hips in the right side.
Results
The pain of the hips in all patients was relieved or disappeared after the operation. The period of postoperative follow-up studied from (5-7.3)years, with an average of6.1years. The results showed44hips got excellent effect and7hips got good effect. Of them, all hips in stage Ⅰ-A(26hips) were excellent, and so did all hips in Ⅰ-B(13hips).There were2excellent hips,3good hips,2fair hips and1poor hips in stage Ⅰ-C. In the Ⅱ-A stage there were3hips occured in excellent stage,4hips in good,2hips in fair and0hips in poor. The rate of excellent and good results was100%(26/26),100%(13/13),62.5%(5/8),77.8%(7/9) in stage Ⅰ-A,Ⅰ-B,Ⅰ-C,Ⅱ-A. The total rate of excellent and good results was91.1%, The total efficiency percentage was98.2%,The best results occured in the stage Ⅰ-A and stage Ⅰ-B. The X-ray films showed obviously in this excellent hips, there was bone pillar shadow formed in the thick passage day by day, the femoral head was not collapsed. The1poor hip in stage Ⅰ-C, the necrotic area was up to60%, the femoral head collapsed in five years
Conclusions
The middle-term effects of marrow core compression with thick passage bone grafting with osteoinduction active material are satisfactory，specially in ARCO Ⅰ-A, Ⅰ-B stage patients.
引文
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[1]崔全军,王义生,王国照.股骨头坏死[M]/罗先正,邱贵兴.人工髋关节学.北京：中国协和医科大学出版社,2003：275
[2]王义生.股骨头缺血性坏死[J].中国矫形外科杂志,2005,13(4)：310
[3]Kevin DP, A fshin R. Management of osteonecrosis of the Femoral head[J]. Orthop Clin North Am,1997,28:461.
[4]Camporesi EM, Vezzani G, Bosco G, et al. J Arthroplasty. Hyperbaric oxygen therapy in femoral head necrosis [J].2010,6:118 - 23.
[5]Steffen RT, Athanasou NA, Gill HS, etal. A vascular necrosis associated with fracture of the femoral neck after hip resurfacing:histological assessment of femoral bone from retrieval specimens [J]. J Bone Joint Surg Br,2010,6:787 - 793.
[6]Quanjun Cui,Wang Y, Saleh KJ, etal. Alcohol-induced adipogenesis in a cloned bone marrow stem cell [J]. J Bone Joint Surg Am,2006,88 (Supp 1 3):148
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