钻孔减压自体松质骨打压植骨结合同种异体腓骨棒植入治疗早期股骨头坏死的近期疗效观察

The short-term results of core decompression with morselized compacted autograft combining nonvascularized allo-fibular-graft for early femoral head necrosis

目的回顾性分析钻孔减压基础上自体松质骨植入结合同种异体腓骨移植治疗早期股骨头坏死(ONFH)(塌陷前期)的近期临床疗效。方法从2009年8月至2011年5月,本组共19例(19髋)诊断为ONFH(FicatⅡ期)患者接受股骨头钻孔减压、经减压通道清除股骨头坏死骨并取转子间区自体松质骨打压植骨,经通道植入经深低温冷冻处理的同种异体腓骨棒治疗。患者年龄26～47岁,平均36.4岁,男17例,女2例。15例为酒精性ONFH,4例为激素性ONFH。其中15例为双侧ONFH,7例一侧因股骨头塌陷同时接受全髋关节置换治疗,8例因另外一侧无症状或已塌陷但临床症状不明显而接受观察、保守治疗。术前采用Harris评分系统进行患髋评分。术后予以对症治疗,定期随访、拍片复查。结果本组16例(16髋)获得随访,失访3例,其中末次电话随访3例(3髋),平均随访14个月。Harris评分由术前74分提高到末次随访时的85分(78～96分)。酒精性ONFH患者和激素性ONFH患者之间术前及术后Harris评分无明显差别。影像学检查显示,移植同种异体腓骨位置良好,顶端位于股骨头关节面软骨下骨5～8mm,平均6.6mm,腓骨顶端于股骨头外上方负重区;无1例发生腓骨脱出。1例1髋病情进展股骨头发生塌陷,无1例接受全髋关节置换治疗。无感染(包括浅表感染和深部移植之腓骨周围感染),无术中、术后股骨转子间或股骨颈骨折发生。结论髓芯减压结合自体松质骨移植基础上,植入同种异体腓骨对早期ONFH近期临床疗效满意,中远期临床效果尚待进一步观察。

Objective The purpose of this study was to assess the short period survivorship,the clinical results and radiographic outcomes of osteonecrosis of the femoral head which was treated with core decompression combined with autografting and nonvascularized allo-fibular grafting.Methods From Aug 2009 to May 2011,19 patients were diagnosed as osteonecrosis of the femoral head（ONFH）.According to Ficat classification system,all patients（19 hips） were classified as Fiat Ⅱ stage and with a good joint motion.The mean age was 36.4 years,and there were 17 males and two females.The patients were treated by core decompression combined with morselized compacted autografting and nonvascularized allo-fibular-grafting.Patients were followed up for Harris hip score,radiographic measures,and survivorship analysis using total hip arthroplasty as the end point.Results 16 patients were followed up through and the mean follow-up period was 14 months.At the final follow-up,the mean Harris score was increased from preoperative 74 point to 85 points.No patient needed total hip arthroplasty,however,the femoral head of one patient had collapsed and progressed to Ficat stage III.No femoral neck fracture,trochanter fracture,or infection was observed.ConclusionsThe early clinical results of core decompression combined with morselized compacted autografting and nonvascularized allo-fibular-grafting for early stage ONFH show encouraging short-term survival rates.However,the long-term clinical results still need follow-up.