羟基磷灰石骨水泥植入治疗股骨头缺血性坏死的中期疗效观察

Implantation of hydroxyapatite methylmethacylate cement in the treatment of osteonecrosis of femoral head: a medium-term evaluation of the results

目的采用羟基磷灰石骨水泥植入治疗各种不同原因所致的股骨头缺血性坏死,并进行中期疗效观察。方法1990年1月～1995年12月期间对FicatⅢ期的7例(8侧)股骨头缺血性坏死患者行死骨清除羟基磷灰石骨水泥植入治疗。术后定期门诊随访,观察疗效,并摄X线片。随访时间5.1～11年,平均7.9年。结果手术前后采用改良MerledAubigné评分法对患髋功能进行评价。单髋病例由术前平均8.66分改善至术后平均15.50分。术后X线片示股骨头外形改善,最后复查时大部分患者的股骨头仍能维持术后的形态,多数病例坏死范围未见扩大,部分病例出现不同程度的退行性变,除2例激素性股骨头坏死患者关节活动受限外,其余患者均对治疗结果感到满意。结论羟基磷灰石骨水泥植入法具有创伤小、手术简单、术后恢复快等优点,适用于某些股骨头缺血性坏死的FicatⅢ期患者,尤其适用于年轻患者。

Objective To introduce a method using hydroxyapatite methylmethacylate cement implanted in the femoral head for the treatment of patients suffering from avascular necrosis of the femoral head due to different causes and to review the medium term follow up results. Methods From January 1990 to December 1995, eight hips in seven patients(male 4, female 3) with femoral head necrosis at Ficat stage Ⅲ were treated with the hydroxyapatite methylmethacylate cement implantation in the involved femoral head. Four osteonecrosis were secondary to femoral neck fracture, two were due to corticosteroid intake and one had alcohol abuse history. All patients complained pain and limited joint activity. The operation consisted of the removal of necrotic bone under weight loading cartilage with curet and the implantation of the hydroxyapatite methylmethacylate cement. The function of hip joint were well evaluated and X ray films were taken pre and postoperatively. The average postoperative follow up was 7.9 years, ranging from 5.1 to 11 years. Results Merle d Aubigné method was used to assess and compare the pre and post operative function of hip joint. The average score for unilateral cases increased from 8.66 to 15.5 at final examination. On radiography, the improvement of the contours of the femoral head was seen in all patients and most of them could preserve their initial postoperative contours during the follow up. No sign of expansion of the bone necrosis appeared in most of the patients, although certain patients presented various joint degeneration such as narrowing of joint space,sclerosis and osteophyte. Subjective evaluation was satisfactory except two suffering from painless limited activity of hip joint. Conclusion This method is relatively simple with less invasion and rapid postoperative recovery. It may be a choice of surgery for the treatment of certain femoral head necrosis at Ficat stage Ⅲ, especially for young patients.