自体或同种异体腓骨联合打压植骨治疗股骨头坏死的初步研究

PRIMARY OUTCOME OF IMPACTING BONE GRAFT AND FIBULAR AUTOGRAFT OR ALLOGRAFT IN TREATING OSTEONECROSIS OF FEMORAL HEAD

目的总结打压、支撑植骨术治疗股骨头坏死的中期疗效,比较采用自体腓骨和同种异体皮质管状骨(下称异体腓骨)行支撑植骨的疗效。方法2004年8月-12月,采用打压、支撑植骨术治疗股骨头坏死40例,分为自体腓骨组和异体腓骨组。自体腓骨组20例(27髋),其中男17例(23髋),女3例(4髋);年龄22～53岁,平均41岁;国际骨循环研究学会(Association Research Circulation Osseous,ARCO)分期Ⅱ期22髋,Ⅲ期5髋。异体腓骨组20例(31髋),其中男17例(25髋),女3例(6髋);年龄18～55岁,平均40岁;ARCO分期Ⅱ期23髋,Ⅲ期8髋。两组一般资料比较差异均无统计学意义(P>0.05)。采用Harris评分评估临床疗效,X线片评估影像学疗效。需再行保髋手术或转行全髋关节置换作为观察终点。结果40例患者均获随访,随访时间36～40个月,平均37.5个月。自体腓骨组与异体腓骨组股骨头保存率分别为92.6%、90.3%。末次随访Harris评分自体腓骨组由术前(70.82±8.26)分提高至(86.36±6.27)分,异体腓骨组由术前(69.94±9.59)分提高至(87.45±7.03)分,两组治疗前后比较差异均有统计学意义(P<0.05),术后两组间比较差异无统计学意义(P>0.05)。影像学评估显示,自体腓骨组和异体腓骨组术后塌陷纠正或未加重分别为17髋(63.0%)和21髋(67.8%),获得良好修复分别为20髋(74.1%)和22髋(71.0%),两组比较差异无统计学意义(P>0.05)。自体腓骨组术后并发症发生于术后负重行走后,而异体腓骨组出现于术后伤口愈合期。结论对于股骨头坏死患者,在经股骨颈植腓骨基础上采用改良的微创打压、皮质支撑植骨技术可取得较好中期疗效。异体腓骨与自体腓骨作为支撑材料,疗效相似。

Objective To evaluate the mid-term outcome of impacting bone graft and strut graft in treating osteonecrosis of the femoral head（ONFH） and to compare the effects of fibular autograft and allograft for strut graft.Methods From August 2004 to December 2004, 40 cases（58 hips） of ONFH were treated with impacting bone graft and nonvascular bular autograft（autograft group） or allograft（allograft group）.In the autograft group, 20 cases（27 hips） included 17 males（23 hips） and 3 females（4 hips） with an average age of 41 years（22-53 years）;22 hips were at stage II and 5 hips at stage Ⅲ according to the classi cation system of Association Research Circulation Osseous（ARCO）.In the allograft group, 20 cases（31 hips） included 17 males（25 hips） and 3 cases females（6 hips） with an average age of 40 years（18-55 years）;23 hips were at stage II and 8 hips at stage Ⅲ according to the classi cation system of ARCO.The outcome was evaluated both clinically by Harris hip score（HHS） and radiologically by X-rays.The related complications were recorded.The end-point of observation was determined when further salvage operation or total hip arthroplasty was needed.Results All cases were followed up for 36-40 months（mean 37.5 months）, 25 hips（92.6%） preserved femoral heads in autograft group and 28 hips（90.3%） in allograft group.Harris score in autograft and allograft groups was increased signi cantly from 70.82 ± 8.26 and 69.94 ± 9.59 before operation to 86.36 ± 6.27 and 87.45 ± 7.03 at the last follow-up, respectively, indicating a signi cant di erence between before and after operation in two groups（P 〈 0.05）, but no signi cant di erence between two groups（P〉0.05）.The radiological results showed that 17 hips（63.0%） in autograft group and 21 hips（67.8%） in allograft group improved or had no further collapse;and 20 hips（74.1%） in autograft group and 22 hips（71.0%） in allograft group were in good repair, indicating no signi cant di erence between two groups（P 〉 0.05）.The postoperative complication occurred after weight-bearing walk in the autograft group and during wound healing stage in the allograft group.Conclusion For selected cases of femur head necrosis, the treatment with modi ed impacting bone graft andstrut graft has a satisfactory mid-term outcome.The results of bular autograft and bular allograft had no signi cant di erence.