骨小梁金属AVN重建棒植入配合中药治疗早期股骨头坏死26例

Trabecular metal rod implantation combined with traditional Chinese medicine application in treating early avascular necrosis of the femoral head in 26 cases

背景:骨小梁金属AVN重建棒为多孔钽金属假体,为MichaelChristie设计并发明,自2001-11在欧洲上市以来已有大量的假体植入,取得良好效果。中医药治疗股骨头坏死具有一定优势,特别是对早、中期患者的疗效良好,关键在于早期诊断与早期治疗是取得良好疗效的关键。目的:观察骨小梁金属AVN重建棒植入配合中药治疗早期股骨头缺血性坏死的临床效果。方法:选择2005-02/2007-06河南省中医院骨科收治的早中期股骨头缺血性坏死患者26例,男16例,女10例;年龄18～56(40.0±2.2)岁;单侧股骨头坏死21例,双侧坏死5例;Ficat分期,Ⅰ期14例,Ⅱ期12例。所有患者均有患髋疼痛,腹股沟中点处深在性压痛,髋关节活动受限,能扶单拐行走者15例,扶双拐行走者8例,卧床不能行走者3例。26例术前采用Harris评分平均(61.5±1.0)分。全部患者均采用骨小梁金属AVN重建棒植入配合中药治疗。结果与结论:26例患者均获得随访,随访时间1～2年。26例患者均顺利植入骨小梁金属AVN重建棒,植入时间10～18min,平均15min。植入后患者切口均Ⅰ期愈合。术后1年Harris评分平均(87.3±1.3)分,与植入前相比差异有显著性意义(P<0.05),优21例,良3例,可2例,优良率92%。植入后均无深静脉栓塞、泌尿系统、肺部感染及压疮等发生。提示骨小梁金属AVN重建棒植入配合中药是治疗早期股骨头缺血性坏死的有效方法。

BACKGROUND： Trabecular metal rod AVN, a kind of porous tantalum metal prosthesis, is first designed by Michael Christie and has received good effects since it was used in Europe from November 2001. Traditional Chinese medicine （TCM） has advantage in treating avascular necrosis of the femoral head （AVN）, especially for those in the early and middle stages. Early diagnosis and treatment play a key role in receiving good therapeutic effect. OBJECTIVE： To explore clinical efficacy of trabecular metal rod implantation with TCM in treating early AVN. METHODS： A total of 26 patients with AVN received treatment at the Department of Orthopaedics, Henan Hospital of Traditional Chinese Medicine, from February 2005 to June 2007, were collected, including 16 males and 10 females, aged 18-56 years （mean 40.0±2.2 years）. There were 21 cases with unilateral AVN, 5 cases with bilateral AVN; according to Ficat system, 14 cases were as stage Ⅰ and 12 as stage Ⅱ. All patients suffered from hip pain and hip activity limitation, including 15 cases walking with the single crutch, 8 cases walking with the support of bilateral crutches, and 3 patients unable to walk. Average value of Harris evaluation was （61.5±1.0） preoperatively. All patients were treated by trabecular metal rod implantation combined with TCM. RESULTS AND CONCLUSION： All cases were followed up for 1-2 years. All 26 patients of AVN were treated by trabecular metal rod implantation successfully during 10-18 minutes （mean 15 minutes）. All wounds healed by first intention. The average value of Harris evaluation was （87.3±1.3） points postoperatively, which has significant difference compared to preoperatively （P 0.05）. The results were excellent in 21cases, good in 3 cases, fair in 2 case, with the excellent and good rate of 92%. In addition, there was no syndrome of infection, bedsore, or deep venous thrombosis in all cases. Trabecular metal rod implantation combined with TCM is a simple and effective means for treating early AVN.