微创减压植骨配合金属骨小梁重建系统植入治疗早中期股骨头坏死的应用研究

Application of minimally invasive decompression bone graft implantation combined with metal trabecular bone reconstruction system for early stage osteonecrosis of femoral head

目的 ：观察微创减压植骨配合金属骨小梁重建系统植入治疗早中期股骨头坏死的应用效果,探讨早中期股骨头坏死保髋治疗方法。方法：2010年1月至2011年6月期间,采用微创减压植骨及金属骨小梁重建系统植入术治疗早中期股骨头坏死患者,共50例（62髋）,男31例（40髋）,女19例（22髋）,发病年龄22~54岁,平均36.2岁;病程6~15个月,平均10.5个月;其中,激素性19例（23髋）,酒精性25例（33髋）,特发性6例（6髋）;ARCO分期：Ⅰ期28髋,Ⅱ期34髋;术前均经影像学检查确诊为股骨头坏死。术后随访观察患者髋关节Harris评分及疗效,进行股骨头生存时间分析。结果：所有患者完成手术,手术时间30~85 min,术中出血量在50~220 ml。47例（58髋）获得随访,随访时间24~46个月,平均34.05个月。末次随访髋关节Harris评分较术前明显提升,差异有统计学意义（P〈0.01）。ARCO分期中Ⅰ期患者与Ⅱ期在Harris评分、疗效及股骨头生存时间方面比较,差异有统计学意义（P〈0.05）。结论：微创减压植骨配合金属骨小梁重建系统植入术在早中期股骨头坏死中的应用效果较好,能显著改善髋关节Harris评分,增加股骨头生存时间,推迟髋关节置换术,且ARCO分期中Ⅰ期效果较优。

Objective：To observe the application effect of minimally invasive decompression,bone graft implantation and metal trabecular bone reconstruction system for early stage osteonecrosis of femoral head and discuss the treatment of hip salvage operation in early stage osteonecrosis of femoral head. Methods：From January 2010 to June 2011,50 patients（62 hips）which were osteonecrosis of femoral head of early stage,were treated with minimally invasive decompression,bone graft implantation and metal trabecular bone reconstruction system,including 31 males（40 hips）,19 females（22 hip）with an av-erage age of 36.2 years old ranging from 22 to 54 years old. The course of disease was from 6 to 15 months（averaged 10.5 months）. Among them,19 cases（23 hips）were steroid induced,25 cases（33 hips）were alcohol induced,6 cases（6 hips） were idiopathic;According to ARCO stage,28 hips were at stageⅠ,34 hips were at stageⅡ. All of them were diagnosed as femoral head necrosis by imaging examination before operation. Then each patient was followed to assess by Harris hip score , curative effect,and conduct the femoral head survival analysis during the postoperation. Results：All patients had finished op-eration,the operation time was between 30 and 85 min,intraoperative blood loss was 50 to 220 ml,and 47 cases（58 hips） were follow up from 24 to 46 months with an average of 34.05 months. As compared with preoperative,the Harris hip score at the last follow up was improved,the difference was statistically significant（P〈0.01）. The Harris hip score,curative effect and survival time of femoral head in ARCO stageⅠwas superior to these in ARCO StageⅡ,the difference was statistically signif-icant（P〈0.05）. Conclusion：Effect of minimally invasive decompression,bone graft implantation combine with the metal tra-becular bone reconstruction system for early stage osteonecrosis of femoral head was good,it could significantly improve the Harris hip score,increase the femoral head survival time,delay the hip replacement,and performance better in ARCO stageⅠ.