灯笼状植骨螺钉治疗股骨头坏死的研究

Lantern -shaped screw loaded with autologous bone for osteonecrosis of the femoral head

目的介绍一种新型的自体骨移植的灯笼状植骨支撑螺钉，评价其治疗山羊早期股骨头坏死（ONFH）的疗效。方法24只单侧山羊股骨头坏死模型确立成功后，随机分成3组。A组未予特殊治疗；B组给予髓芯减压结合自体骨移植治疗；C组给予负载自体骨移植的灯笼状植骨支撑螺钉治疗。在术后的4、8、12、16周给予影像学（双髋关节正位片及CT平扫）评估；术后16周处死动物，组织学观察股骨头坏死修复情况以及检测股骨头标本生物力学。结果影像学上，A组表现了典型的股骨头坏死，且股骨头在16周时出现了塌陷；而C组山羊在16周时股骨头表面完整光滑，未见明显塌陷；B组在16周时股骨头见不规则表面；C组在组织学及影像学上表明，在螺钉负重区见到了大量修复的骨小梁组织，且有新生骨长入；而在B组股骨头负重区见到了较多的增生纤维组织形成，少量新生骨。c组股骨头轴向强度（股骨头轴向单位面积的压力）为（42．15±0．65）mPa，明显大于A、B组[（28．19±0．18）、（35．40±0．28）mPa]，差异有统计学意义（P=0．000）。结论新型的灯笼状植骨支撑螺钉在防止股骨头负重区塌陷具有良好的作用，它既能提供新的环境促进新骨形成，又可加强负重区的生物力学结构重建。

Objective To introduce a novel lantern - shaped screw loaded with autologous bone and to assess the efficacy for the treatment of early osteonecrosis of the femoral head （ ONFH ） in a goat model. Methods Twenty - four goats with unilateral ONFH were induced. After core decompression, the goats were randomly divided into three groups. Group A, the goats were not given any treatment after model was established. Group B, the goats were treated by traditional core decompression combined with auto- graft. Group C, the goats were treated by core decompression utilizing lantern - shaped screw loaded with autologous bone. All the goats were given radiographic （X ray, CT scans） assessment at the time points of 4, 8, 12, 16 weeks postoperatively. Goats were sacrificed at the 16th week to evaluate the histological ob- servation and biomechanieal properties. Results Signs of typical osteonecrosis were found in group A, and collapse of the femoral head appeared at 16th week. After sixteen weeks, we found that the surface of femoral head was normal in group C; while an irregular surface or part of collapse was seen in group B. Histological and radiographic results both suggested that a continuous trabeeular bone structure and thriving bone in - growth was abundant in the region of lantern - shaped support in group C. Fibrous tissue was ob- vious in group B with little bone in - growth. The strength of the femoral head was （42. 15±0. 65） mPa in group C, superior to group A and B significantly （ P = 0. 000）. Conclusion The progression of the col- lapse of the cartilage may be postponed by lantern - shaped screw loaded with autologous bone in the treat- ment of ONFH. It can not only provide appropriate circumstance to facilitate new bone remodeling but also strengthen hiomechanical structure for the load - bearing region.