非细胞型组织工程骨联合钛棒微创植入治疗股骨头早期坏死的疗效分析

Analysis of clinical effect of non-cellular tissue engineering bone combined with Titanium rod after minimally invasive grafting in the treatment of early stage osteonecrosis of the femoral head

目的评估非细胞型组织工程骨联合钛棒微创植入治疗早期股骨头坏死（osteonecrosis of the feilloral head，ONFH）的临床疗效，方法2003年1月至2006年6月，确诊早期ONFH32例（42髋）；国际骨循环研究学会分期：Ⅰ期8髋，ⅡA期11髋，ⅡB期13髋，ⅡC期10髋；在X线透视定位及关节镜监视下，经皮微创行髓芯减压，植入非细胞型组织工程骨，并钛棒支撑股骨头软骨下骨质。术后6、12、24、36个月时随访，临床评价包括：疼痛评分、Harris评分、X线片病情评价及以全髋关节置换作为失败终点的生存率分析。结果患者术后疼痛及Harris评分指数各时间段（不含第24个月）之间前后比较及与术前比较，差异均有统计学意义。X线分期比较，术后16个月1例ⅡB期进展为ⅡC期，术后24个月2例ⅡC髋病变加重，股骨头塌陷，30个月后行全髋关节置换术。术后患者总改善率88．1％，与激素应用有关的Ⅱ期病变3年生存率最低；Ⅰ期病变治疗改善率最佳，ⅡA期、ⅡB期改善率次之，ⅡC期改善率最低，无变化及加重患者均为激素性ONFH病例。结论非细胞型组织工程骨联合钛棒微创植入，除对ONFHⅡC期激素性病变疗效改善极差应慎重选择外，对Ⅰ～ⅡC期病变可有效防止股骨头塌陷。

Objective To evaluate the clinical effect of non-cellular tissue engineering bone combined with Titanium rod in the treatment of early stage osteonecrosis of the femoral head （ONFH）. Methods From Januai7 2003 to June 2006, 32 early stage ONFH patients （48 hips） were included. Based on Associa- tion Research Circulation Osseous staging, 8 hips were rated as stage Ⅰ, 11 as ⅡA, 13 as ⅡB, and 10 as ⅡC. By X-ray and arthroseopy navigation, the pereutaneous core decompression was performed and the non-cellular tissue engineering bone was grafted, eombined with Titanium rod supporting the sclerotin under the cartilage. The patients were followed up at the 6th, 12th, 24th and 36th month postoperatively. Clinieal evaluations included： pain score, Harris hip score, the change of the X-ray images and the evaluation of the ratio of total hip arthroplasty （THA}. Results The pain score and the Hart＇is hip score had a statistical significanee by the comparison between the preoperative and postoperative patients and the comparison among the patients at eaeh time point postoperatively （except the 24th month）. Sixteen months postoperatively, one stage ⅡB hip progressed to IIC; the femoral head of two hips collapsed 24 monlhs postoperatively and were performed THA finally. The patients wbo had accepted the therapy of the hormone had a worst survival rate; the total improvement rate was 88.1%. The patients of stage Ⅰ had the best improvement rate, and the patients of stage ⅡC were the worst. All patients who had a hormone-using history had no changes or even got worse. Conclusion Non-cellular tissue engineering bone eombined with Titanium rod minimally invasive grafting is effective in the treatment of early ONFH, from stage I to IIC, except ⅡC patients who had a history of the use of the hormone, and it can prevent the femoral head from collapsing.