同种异体螺纹骨笼结合脱钙骨基质治疗成人股骨头缺血性坏死

Treatment of osteonecrosis of the femoral head with implantation of allogeneic bone support frame and decalcified bone matrix

目的探讨采用同种异体螺纹骨笼结合脱钙骨基质（DBM）治疗早、中期股骨头缺血性坏死（ONFH）的中期随访效果。方法采用同种异体骨支撑架结合DBM治疗40例（60髋）ONFH患者并随访观察。按Ficat分期：Ⅱ期35髋,Ⅲ期25髋。结果 40例（60髋）获随访,时间9年6个月~12年5个月。术后Harris评分为（82.78±10.77）,与术前（53.20±15.72）分比较差异有统计学意义（P〈0.01）。其中优29髋,良20髋,可3髋,差8髋,优良率81.7%。差评的8髋全部行人工全髋关节置换术。结论同种异体螺纹骨笼联合DBM治疗成人ONFH手术损伤小,特别是适合治疗早期ONFH的年轻患者,中期疗效满意,能有效防止股骨头塌陷。

Objective To explore the midterm efficacy of applying allogeneic bone cage support combining with decalcified bone matrix（ DBM） in the treatment of osteonecrosis of femoral head（ ONFH）. Methods 40 cases（ 60hips） with ONFH underwent core decompression and allogeneic threaded bone supporting cage which was loaded with decalcified bone matrix inside. Among these cases,thirty-five hips were classified as stageⅡ and 25 as stage Ⅲ according to Ficat standard. Results All of the cases（60 hips） were followed up for 114 ~ 149 months. Harris score at postoperation（ 82. 78 ± 10. 77） and preoperation（ 53. 20 ± 15. 72） were significantly different beween the two groups（ P〈0. 01）. Twenty-nine hips were rated as excellent,20 good,3 fair and 8 poor. A total of 81. 7% of overall clinical results were rated as good or excellent. Eight poor cases were turned to total hip replacement. Conclusions Allogeneic bone cage support combining with DBM,which features a prevention of femoral head collapse,is suitable and minimally invasive for managing early stage ONFH in young cases and middle-term effect is optimal.