股骨头成形术治疗股骨头缺血性坏死的实验研究

Femoral Head Plastic Operation in the Treatment of Aseptic Necrosis of Femoral Head(An Experiment Study)

目的制作股骨头缺血坏死(avascular necrosis of femoral head,ANFH)模型,探讨股骨头成形术(填充骨水泥)对ANFH的治疗效果。方法将60只中国大白兔随机分为正常组、自然修复组、骨水泥组和造影剂骨水泥组,每组15只。除正常组外,余3组造成右侧ANFH模型。骨水泥组造模后填充骨水泥,造影剂骨水泥组造模后填充造影剂骨水泥。术后观察4组后肢活动情况。4组均于术后12周处死,取股骨头标本观察股骨头外形、关节软骨性状,分别行病理学检查及生物力学实验并进行比较分析。结果术后1周内,除正常组外,余3组右侧后肢均轻度跛行。骨水泥组、造影剂骨水泥组右侧肢体随时间延长基本恢复正常活动,而自然修复组肢体仍活动受限。骨水泥组和造影剂骨水泥组股骨头标本外形完整无变形,关节软骨面透明度好,表面光滑、平整;自然修复组右侧股骨头塌陷,关节软骨面浑浊,表面粗糙不平并出现裂隙。正常组、骨水泥组、造影剂骨水泥组股骨头软骨厚度均高于自然修复组(P<0.01),术后抗压强度和刚度均高于自然修复组(P<0.05,P<0.01);与其他3组比较,骨水泥组刚度最强,差异均有统计学意义(P<0.01)。结论股骨头成形术操作简单、创伤较小,可以保持股骨头外形完整,有望成为治疗F icatⅡ期或Ⅲ期ANFH坏死的新型手术方法。

Objective To discuss the femoral head plastic operation for prevention and treatment of aseptic necrosis of the femoral head （ANFH）. Methods 60 Chinese white rabbits were randomly divided into normal group, natural recovery group, bone cement group and the contrast agents of bone cement group, with 15 in each group. The four groups, except the normal Group, were made of ANFH modle. The bone cement group was filled with bone cement after being made defect, and the contrast agents of bone cement group was filled with bone cement added with barium sulfate agent after being rendered defect. Hind limb movement after operation was observed. In the 12th week, all rabbits were killed, and femoral head shape of the femoral head, and articular cartilage properties were observed through specimen, and also pathological examination and biomechanical testing were taken and analyzed respectively. Results 1 week after surgery, the other 3 groups, except the normal group, had right hind limbs of mild claudication. But the activities in the bone cement group and contrast bone cement group returned to normal, and activities in the natural recovery group was still limited physically. Bone cement group and the contrast agent of bone cement group had a complete shape without deformation, articular cartilage transparency, and smooth surface. Natural recovery group had collapse of right femoral head, muddy articular cartilage surface, rough surfaces＇ and the emergence of crack. Cartilage thickness in the normal group, bone cement group and contrast angents of bone cement group was thicker than that in the natural recovery group, and the difference was statistically significant （P 〈 0. 01 ）. Compressive strength and stiffness in 3 groups were lower than that in the natural recovery group, the difference was statistically significant （ P 〈 0. 05, P 〈 0. 01 ）. When compared with the other 3 groups, the stiffness in bone cement group was strongest, the difference was statistically significant （ P 〈 0. 01 ）. Conclusion Femoral head plastic operation is simple, less invasive and can maintain the integrity of the femoral head outline. It may be used as a new ap- proach to treat young patients in Ficat Ⅱ - Ⅲ.