髓芯减压自体红骨髓组织工程复合物移植与联合空心钛钉支撑的复合物移植治疗早期股骨头坏死疗效比较

Comparison of the clinical results of core decompression,autologous red bone marrow tissue engineering bone with or without the use of titanium cannulated screws in treating early necrosis of femoral head

目的比较髓芯减压自体红骨髓(ARBM)组织工程复合物移植与联合空心钛钉支撑的复合物移植治疗早期股骨头坏死(NFH)的疗效,为临床合理应用提供依据。方法在C臂X线机及关节镜监视下行髓芯减压、刮除坏死骨,对照组仅植入ARBM与骨诱导活性材料(OAM)组成的组织工程复合物,治疗组联合空心钛钉支撑股骨头软骨下骨质。术后定期随访,数据经统计学处理。结果在疼痛评分、Harris髋关节评分、X线表现及临床疗效方面,对NFHⅠ期病变两组治疗效果相同,但对NFHⅡ期病变治疗组明显优于对照组。结论髓芯减压、ARBM组织工程复合物植入对于早期NFH的治疗有极好的修复作用,对NFHⅡ期病变联合空心钛钉支撑,在疗效改善及防止股骨头塌陷、避免行全髋关节置换方面具有独特优越性。

Objective To study the clinical results of different way for treating necrosis of femoral head（NFH）,while means core decompression and transplant of tissue engineering bone with or without the use of titanium cannulated screws to offer the evidence for clinic practice.Methods The necrosis bone was cleared and core decompression was done under C-arm and then the tissue engineering bone composed of autologous red bone marrow（ARBM） and osteoinductive absorbing material（OAM） was transplanted in the body only as control group,while titanium cannulated screws were used to support the subchondral bone as the treatment group.All the patients were followed up regularly after the surgery,and statistics analysis was used to deal with the data.Results Neither of the methods showed better result in patients whom belonged to the stageⅠof NFH in scores of pain,Harris′scores and the performance of X-ray and clinical results,but the treatment group showed better results in the patients whom belonged to the stageⅡ.Conclusions Core decompression and transplant of ARBM tissue engineering bone shows satisfactory results in treating early NFH,while combined with the titanium cannulated screws,it present better result in preventing the collapse of femoral head in the stageⅡ.