同种异体骨支撑架微创治疗股骨头坏死的临床研究

Mini-invasive treatment of osteonecrosis of the femoral head with implantation of allogeneic bone support frame

目的应用改良髓芯减压术结合同种异体骨支撑架加自体骨和脱钙骨基质（decalcified bone matrix，DBM）治疗早期股骨头坏死，探索早期股骨头坏死的微创治疗方法。方法2004年1月～2005年4月，23例24个髋关节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拧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。观察手术前后Harris评分变化、x线影像学表现及是否需进一步治疗。结果本组所有患者均获得随访，平均随访19（12—27）个月，以最后一次随访资料作为最终评价依据。Harris评分，术前优良率为43．5％（10／23）。术后优良率为91．3％（21／23）。22侧髋关节影像学表现保持稳定，无明显并发症发生。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，增加了股骨头负重区软骨下骨的机械支撑，成骨作用强，有利于股骨头坏死的修复与重建，同时，不破坏患者股骨头本身的血液供应，创伤小，操作简单，值得临床推广使用。

Objective To investigate a new minimally invasive method in the treatment of avascular necrosis of femoral head at early stage. Methods We treated 23 patients （ 24 hips） with stage Ⅰ , Ⅱ, or Ⅲ osteonecrosis of the femoral head, according to the Ficat and Arlet Classification System, from January 2004 to April 2005. The hips were treated with modified core decompression and an implantation of allogeneic frozen-drying, radiation-sterilized bone support frame containing autologous cancellous bone and decalcified bone matrix until 5 mm beneath the articular cartilage. All the patients were followed and the outcomes were evaluated by the changes of the Harris hip scores, the progression in radiographic stages, and the need for additional treatment. Results All the patients were followed for a mean of 19 months （range, 12 - 27 months）. The rate of excellent-or-good results in the Harris hip scores was improved from 43.5% （10/23） preoperatively to 91.3% （21/23） postoperatively. A total of 22 hips was radiologically stable. No major complications occurred. Conclusions The implantation of allogeneic bone support frame containing autologous cancellous bone and decalcified bone matrix is one of favorable alternatives 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 at stage Ⅰ -Ⅲ.