钛合金支撑架结合自体骨和DBM治疗股骨头坏死

Treatment of osteonecrosis of the femoral head with implantation of titanium alloy support frame,autologous bone and decalcified bone matrix

【目的】探讨空心钛合金支架植入结合自体松质骨和脱钙骨基质（DBM）治疗成人股骨头坏死初步疗效。【方法】采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的空心钛合金支架经隧道置入骨坏死区直至软骨下骨约5mm处，髓道远端用自体髂骨填塞。【结果】经临床应用13例。15个髋关节，随访14-36个月，并按成人股骨头缺血性坏死疗效百分评价法进行评价，优良率为93．3％。【结论】空心钛合金支架植入结合自体松质骨和DBM治疗成人股骨头坏死具有以下优点：（1）手术操作简单，不破坏患者股骨头本身的血液供应，创伤小。（2）将具有骨诱导活性的DBM直接放入骨坏死区，成骨作用强。（3）增加股骨头负重区软骨下骨的机械支撑，降低局部应力，有利于股骨头坏死的修复及重建。

[ Objective] To introduce a new method for the treatment of avascular necrosis of the femoral head. [ Method ] We studied thirteen patients （fLfteen hips） with stage- Ⅰ , Ⅱ or Ⅲ osteenecrosis of the femoral head. According to Ficat and Arlet Classification System, the hips were treated with modify core decompression and implantation of titanium alloy support frame, autologous bone and decalcified bone matrix. [ Result] All the patients were followed up for an average of 27 months （ranged, 14 - 36 months） . Preoperatively, 2 hips were of Ficat Arlet stage Ⅰ , 10 stage Ⅱ and 3 stage Ⅲ. Postoperatively, twelve patients were pain free, one had mild pain. No major complications occurred. [ Conclusion] It is one of the better alternatives that can prevent the necrosis femoral head from progressing to collapse and can promote revaseulafization and new bone formation by direct mechanical support. The technique is suitable for the treatment of avascular necrosis of femoral head of stage Ⅰ to Ⅲ.