同种异体骨支撑架结合自体骨和DBM治疗股骨头坏死

Treatment of Osteonecrosis of Femoral Head with Implantation of Allogeneic Bone Support Frame,Autologous Bone and Decalcified Bone Matrix

目的探讨同种异体骨支撑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的同种异体骨支撑架经隧道置入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。结果经临床应用23例24个髋关节，随访12～27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95.8％。结论同种异体骨支撑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，且不增加日后行人工关节置换的困难；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 investigate a new method for the treatment of avascular necrosis of the femoral head. Methods Twenty- three patients （twenty- four hips） with stage Ⅰ , Ⅱ and Ⅲ osteonecrosis of the femoral head, according to Ficat and Arlet classification system. The hips were treated with modified core decompression and implantation of allogeneic freeze - drying, radiation sterilization bone scaffold, autologous bone and decalcified bone matrix. Results All the patients were followed up for a mean of 19 months （from 12 to 27 months）. Preoperatively, four hips were Ficat Arlet stage Ⅱ , fourteen stage Ⅱ and six stage Ⅲ. Postoperatively, twenty- two patients were pain free while one had mild pain. No major complications occurred. Conclusion It is one of the better alternaflves that can prevent the necrosis femoral head from progressing to collapse and promote revascularization 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.