两种强化股骨头力学结构治疗股骨头坏死临床疗效比较

Comparison of clinical results for implantation of allogeneic bone support frame and titanium alloy support frame for treatment of osteonecrosis of the femoral head

[目的]比较同种异体骨支撑架/自体松质骨/脱钙骨基质（DBM）与钛合金支撑架/自体松质骨/脱钙骨基质（DBM）分别植入行髓芯减压后的股骨头,强化其力学结构,治疗股骨头坏死的疗效。[方法]2001年1月～2004年8月治疗成人股骨头坏死（FicatⅠ～Ⅲ期）63例（68髋）,在股骨头坏死行髓芯减压后分别植入同种异体骨支撑架/自体松质骨/DBM（A组）和钛合金支撑架/自体松质骨/DBM（B组）,A组32例（34髋）,B组31例（34髋）,分别观察2组病例的手术时间、术中出血量、Harris髋关节评分、X线影像学进展情况及并发症的发生率。[结果]两组所有患者均获得随访,平均随访47个月（24～67个月）,以最后1次随访资料作为最终评价依据。两组在手术时间、术中出血量、Harris评分变化、X线影像学进展情况及并发症的发生率方面均无显著性差异,但两组术后的Harris评分均较术前明显提高,差异有显著性。[结论]同种异体骨支撑架结合自体松质骨和DBM植入治疗成人股骨头坏死,和钛合金支撑架一样能增加股骨头负重区软骨下骨的机械支撑,有利于股骨头坏死的修复与重建。能用同种异体骨支撑架代替钛合金支撑架以加强股骨头软骨下骨的机械强度治疗股骨头坏死。

[Objective]To compare the clinical results of the treatment of osteonecrosis of the femoral head with implanting allogeneic bone support frame and alloy support frame.[Method]Patients with Ficat-Ⅰ,Ⅱ,or Ⅲ osteonecrosis were randomly assigned to be treated either with implantation of allogeneic bone support frame,autologous bone and decalcified bone matrix or with implantation of titanium alloy support frame,autologous bone and decalcified bone matrix.The allogeneic bone support frame group （group A） consisted of thirty-two patients （thirty-four hips）,and the titanium alloy support frame group （group B） consisted of thirty-one patients （thirty-four hips）.The patients in these two groups had similar demographic characteristics,duration and stage of disease,and duration of follow-up.The evaluation parameters included the operative time,the volume of blood loss,Harris hip scores,radiographic assessment and the incidence of complication.[Result]All the patients were followed up for a mean of 47 months （range,24～67 months）.The mean Harris hip score improved for 91.3% of the hips in group A： twenty hips （59%） were rated excellent,ten （29%） were rated good and four （12%） were rated fair,excellent and good rate was 88.2%.The mean Harris hip score improved for 90.7% of the hips in group B： twenty hips （59%） were rated excellent,eleven （32%） were rated good and three （9%） were rated fair,excellent and good rate was 91.2% （P〈0.01）.[Conclusion]The allogeneic bone support frame implanting,just like the alloy support frame implanting,could increase mechanical support and decrease the stress for femoral head.It could promote revascularization and new bone formation for necrotic femoral head.