髓心减压及异体骨笼结合脱钙骨基质治疗股骨头坏死临床研究(英文)

Structural augmentation with biomaterial loaded allograft threaded cage for the treatment of femoral head osteonecrosis:surgical technique

[目的]回顾性分析髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入治疗早期股骨头坏死的临床疗效，探讨其影响因素。[方法]本院于2000年2月～2006年8月间收治早期股骨头坏死76例（78髋），均采用髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入，术后预防性的静脉给予抗生素及抗凝治疗，并限制负重。临床评估采用Harris评分系统，评估术后患髋功能的改善情况，并定期行X线检查。[结果]76例均获得随访（24—68个月），术后进行疗效评估。参考Harris评分系统，术前的平均Harris评分为62．8分，术后平均评分为81．6分。髋关节影像学表现稳定，股骨头无坏死进展。[结论]髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头坏死临床效果满意，有利于骨坏死的修复和重建，适合于Ⅰ期和Ⅱ期股骨头坏死的患者。

[ Objective] To introduce the surgical technique and its rationale and to evaluate the early and mid-term clinical outcome of routine core decompression and insertion of a biomaterial loaded allograft threaded cage （ATC） in the treatment of necrotic femoral head. [ Methods] Seventy-six patients （78 hips） with femoral head necrosis were allocated to a program of either core decompression or core decompression and implantation of ATC. [Results] At review all patients had a minimum follow-up of 24-months （24 to 68 months）. In the control group, no significant improvement in Harris hip score （HHS） was found, and 13 of the 22 hips had deteriorated to stage Ⅲ. In the treatment group, the mean HHS was improved from 62. 8 to 81. 6. Collapse was seen in 1 hip, and this collapse was progressive in 3 hips. [ Conclusion ] It＇s thus evident that the technique is attractive as a salvage procedure, which shows encouraging success rates and early clinical results.