股骨头髓芯减压为基础治疗早期股骨头坏死

Methods based on core decompression for treating early-stage femoral head necrosis

背景:髓芯减压治疗早期股骨头坏死效果较好,而且髓芯减压方法简单易行,即使远期治疗效果不理想也不影响行人工全髋关节置换。目的:探讨以股骨头髓芯减压为基础的3种方法治疗早期股骨头坏死的临床疗效。方法:根据国际骨循环研究学会(Association Research Circulation Osseous,ARCO)股骨头坏死分期标准,纳入股骨头坏死患者46例(61髋),Ⅰ期21例(29髋),Ⅱ期25例(32髋)。其中15例(23髋)行单纯髓芯减压治疗,18例(25髋)行髓芯减压联合自体骨髓单个核细胞移植治疗,13例(13髋)行髓芯减压联合多孔钽棒置入治疗。结果与结论:全部患者均获12个月随访,3组患者末次随访时髋关节Harris评分均高于术前(P<0.01),末次随访时联合细胞移植组和联合多孔钽棒组Harris评分高于单纯髓芯减压组(P<0.01),而联合细胞移植组和联合多孔钽棒组比较差异无显著性意义(P>0.05)。髋关节X射线检查:单纯髓芯减压组2例(3髋)发展为塌陷、联合细胞移植组1例(1髋)发展为塌陷,联合多孔钽棒组2例(2髋)出现塌陷。结果可见以股骨头髓芯减压为基础的3种方法治疗早期股骨头坏死均有效,其中髓芯减压联合自体骨髓单个核细胞移植或多孔钽棒置入近期疗效优于单纯髓芯减压治疗。

BACKGROUND： Core decompression can relieve the symptoms of early-stage femoral head necrosis effectively. This method is simple and feasible. Even if the long term result is not ideal, artificial total hip replacement can be performed with no influence. OBJECTIVE： To explore the clinical effect of three methods based on core decompression in treating the early-stage femoral head necrosis. METHODS： Forty-six cases （61 hips） with femoral head necrosis were included. There were 21 cases （29 hips） in phaseⅠ, 25 cases （32 hips） in phase Ⅱ based on Association Research Circulation Osseous classification. They were all treated with core decompression, of which 15 cases （23 hips） were only treated with core decompression （group A）, 18 cases （25 hips） were treated with core decompression and autologous bone marrow mononuclear cells implantation after separation and collection of bone marrow mononuclear cells （group B）, 13 cases （13 hips） were treated with core decompression plus porous tantalum rod insertion （group C）. RESULTS AND CONCLUSION： All the patients were followed-up for 12 months. The last follow-up Harris scores of three groups were higher than that of preoperation （P 0.01）. The Harris score of last follow-up in group B and group C was higher than that in the group A （P 0.01）, and there was no significant difference between group B and group C （P 0.05）. Postoperative X-ray image showed that 2 cases （3 hips） developed to femoral head collapse in group A, while 1 case （1 hip） in group B and 2 cases （2 hips） in group C developed to femoral head collapse. The three methods based on core decompression have positive effect in treating early stage femoral head necrosis. The effect of core decompression combined with autologous bone marrow mononuclear cells implantation or porous tantalum rod insertion was superior to simple core decompression.