关节镜下髓芯减压、自体松质骨复合骨形态发生蛋白移植术治疗股骨头坏死

Treatment for ischemic necrosis of the femoral bead with autogenous spongy bone morselized and BMP implantation after arthroscopic core decompression

目的 观察关节镜下髓芯减压、自体松质骨复合骨形态发生蛋白（BMP）移植术治疗早期股骨头坏死的的临床效果.方法 回顾性分析23例（30髋）采用关节镜下髓芯减压、自体松质骨复合BMP植入治疗的股骨头坏死患者的临床资料.结果 23例患者（30髋）均治愈出院,术后3～6个月X线片复查显示原病灶区骨小梁逐渐清晰匀化,观察期间ⅡC期1例、ⅢB期1例术后股骨头骨折、塌陷,原有疼痛症状加重,而行全髋关节置换术,其他患者多能维持术后6个月内所获得的改善结果.该组术后综合评分40～92分,总优良率76.7%[其中Ⅰ期（5 髋/5髋）、Ⅱ期（12髋/16髋）、Ⅲ期（6髋/9髋）];随访12～36个月（平均20.4个月）,髋关节疼痛消失或明显减轻,功能明显改善,X线片复查见股骨头轮廓光滑,关节间隙正常.结论 关节镜辅助下髓芯减压、自体松质骨复合BMP移植术治疗早期股骨头坏死疗效好,并发症发生少.

Objective To observe the clinical results of treatment for ischemic necrosis of the femoral head with autogenous spongy bone morselized and BMP implantation after arthroscopic core decompression.Methods Retrospectively analyzing the clinical data of 23 cases（30 hips）,who were treated with autogenous cancerous bone morselized and BMP implantation after arthroscopic core decompression.Results 23 patients were followed up after discharge,follow-up time was 12 to 36 months,with an average of20.4 months.X-ray demonstrate good bone restoration in femoral head.In the observation period,femoral fractured or collapsed in 1 case of stageⅡ C、1 case of stage ⅢB,the original pain symptom aggravating,so artificial joint replacement were implemented.The other cases can maintain the results obtained in postoperative 6 months.According to the comprehensive evaluation.all the cases were 40～92scores after treatment.The rate of excellent and good results Was 76.7%.The results were better in stage Ⅰ（5/5）,Stage Ⅱ（12/16）,and Stage Ⅲ（6/9）.Hip pain disappeared or lightening obviously,function improved obviously,Xray demonstrate femoral head contour smoothly and joint clearance normal.Conclusion Autogenous spongy bone morselized and BMP implantation after arthroscopic core decompression had good clinic curative effects in treatment of inchoate ischemic necrosis of the femoral head.