髓芯减压及非细胞型组织工程骨植入并钛棒支撑治疗早期股骨头坏死

Bouche decompression and implantation of acellular tissue engineered bone with titanium rods for treating early necrosis of the femoral head

背景:临床研究中发现对于FicatⅡ期股骨头坏死尤其合并骨质疏松的病例,单纯髓芯减压伴或者不伴非细胞型组织工程骨植入治疗股骨头塌陷的发生率均较高。目的:分析髓芯减压+非细胞型组织工程骨植入联合钛棒支撑治疗早期股骨头坏死的近期疗效。方法:选择35例(40髋)早期股骨头坏死患者,观察组15例(20髋)行髓芯减压+非细胞型组织工程骨植入联合钛棒支撑治疗,骨坏死Ficat分期,Ⅰ期10髋,Ⅱ期10髋;对照组20例(20髋)行髓芯减压+非细胞型组织工程骨植入治疗,骨坏死Ficat分期,Ⅰ期11髋,Ⅱ期9髋。治疗后随访1年,评估目测类比评分、髋关节功能Harris评分及骨坏死进展情况。结果与结论:(1)两组治疗后1年随访时的Harris评分及目测类比评分均优于治疗前(P<0.001);观察组治疗后1年随访时Harris评分优于对照组(P<0.05),目测类比评分与对照组比较无差异(P>0.05);(2)对于骨坏死Ficat分期Ⅱ期患者,治疗后1年随访时,根据Harris评分,观察组治疗优良率高于对照组(80%,40%,P<0.05);根据Ficat分期进展,观察组治疗有效率高于对照组(90%,80%,P<0.05);(3)对于Ficat分期Ⅰ期患者,治疗后1年随访时均表现为病变修复较好,髋关节无退变、软骨下骨无塌陷;(4)结果表明,髓芯减压+非细胞型组织工程骨植入与髓芯减压+非细胞型组织工程骨植入联合钛棒支撑都是治疗早期股骨头坏死的有效方法,髓芯减压+非细胞型组织工程骨植入联合钛棒支撑治疗早期股骨头坏死的近期疗效更优。

BACKGROUND： For the Ficat Ⅱ of femoral head necrosis especially with osteoporosis, core decompression with or without acellular tissue engineered bone can result in a higher incidence of femoral head collapse. OBJECTIVE： To analyze the clinical effect of core decompression plus implantation of acellular tissue engineered bone with titanium rods in the treatment of early necrosis of the femoral head. METHODS： Thirty-five hospitalized patients with early necrosis of the femoral head （40 hips） were enrolled in the study and assigned into a observation group （15 cases with 20 hips, including 10 hips of Ficat I, 10 hips of Ficat Ⅱ） and a control group （20 cases with 20 hips, including 11 hips of Ficat Ⅰ, 9 hips of Ficat Ⅱ）. Core decompression plus implantation of acellular tissue engineered bone with titanium rods were conducted in the observation group, while Bouche decompression with implantation of acellular tissue engineered bone was done in the control group. All the patients were followed up for 1 year. Visual analogue scale （VAS） score, Harris hip function score, and progression in necrosis of the femoral head were compared between two groups. RESULTS AND CONCLUSION： VAS scores and Harris scores at 1-year follow-up in both groups showed better outcomes （P 〈 0.001）. At the end of 1-year follow-up visit, the Harris score was significantly higher in the observation group than the control group （P〈0.05）, while there was no difference in the mean VAS scores between the two groups （P 〉 0.05）. For Ficat II patients, the excellent/good rate in the observation group was higher than that in the control group at the last follow-up （80% vs. 40%, P〈0.05）. According to the Ficat staging, the effective rate in the observation group was higher than that in the control group （90% vs. 80%, P〈0.05）. During the postoperative 1-year follow-up visit, Ficat Ⅰ patients presented with better repair of lesions, no degeneration of the hip joint, and no subchondral bone collapse. Overall, it is an effective treatment for early necrosis of the femoral head by core decompression plus implantation of acellular tissue engineered bone with or without titanium rods; however, co-implantation with titanium robs can show better short-term outcomes.