多小孔立体髓芯减压联合自体骨髓移植治疗Ⅰ、Ⅱ期股骨头缺血坏死

Curative effect of three-dimensional porous core decompression combined with autologous bone marrow transplantation on phase Ⅰ、Ⅱ avascular necrosis of the femoral head

背景:早期股骨头缺血性坏死提倡保髋治疗。在各种治疗早期股骨头坏死的方法中,髓芯减压的疗效已经得到公认。目的:比较单纯髓芯减压与多小孔立体髓芯减压联合自体骨髓移植治疗Ⅰ/Ⅱ期股骨头缺血坏死的临床疗效。方法:对泸州医学院附属第一医院2011年3月至2016年5月收治的ARCOSⅠ/Ⅱ期股骨头缺血性坏死患者30例(39髋)进行手术干预,并进行术后随访。其中试验组17例22髋,其中ARCOSⅠ期10髋,Ⅱ期12髋,行多小孔立体髓芯减压联合自体骨髓移植治疗;对照组13例17髋,其中ARCOSⅠ期7髋,Ⅱ期10髋,行单纯髓芯减压治疗。治疗后第1,3,6,9,12,18,24,30,36个月随访,采用Harris评分标准、X射线、磁共振检查对手术疗效进行评价。结果与结论:(1)术后2组患者手术创面均Ⅰ期愈合,无并发症出现;(2)随访1-3年,末次随访时2组Harris评分均较术前显著提高(P<0.05);在治疗后的Ⅰ期股骨头坏死患者中,试验组Harris评分较对照组高,且差异有显著性意义(P<0.05);在治疗后的Ⅱ期股骨头坏死患者中,试验组Harris评分较对照组高,且差异有显著性意义(P<0.05);(3)试验组(22髋)ARCOSⅠ期1髋、ARCOSⅡ期1髋股骨头坏死进一步加重出现塌陷,行人工关节置换;对照组(17髋)ARCOSⅠ期3髋、ARCOSⅡ期5髋股骨头坏死进一步加重出现塌陷,行人工关节置换。试验组中股骨头坏死进一步加重的患者数量明显少于对照组,且差异有显著性意义(P<0.05);(4)结果提示,与单纯髓芯减压相比,多小孔立体髓芯减压联合自体骨髓移植对于Ⅰ/Ⅱ期股骨头缺血坏死更具有改善功能、延缓病程的作用。

BACKGROUND:Hip-preserving treatment is advocated in the treatment of early avascular necrosis of the femoral head.OBJECTIVE:To compare the clinical efficacy of simple core decompression and three-dimensional porous core decompression combined with autologous bone marrow transplantation on early avascular necrosis of the femoral head.METHODS:Thirty patients(39hips)with early avascular necrosis of the femoral head at phase I-II according to thestaging criteria of the Association Research Circulation Osseuse(ARCO)who had been admitted to the First Affiliated Hospital of Luzhou Medical University between March2011and May2016were surgically treated and followed up.Seventeen patients(22hips,trial group)were treated with three-dimensional porous core decompression combined with autologous bone marrow transplantation,including10cases of ARCO stage I and12cases of ARCO stage II;the other13patients(17hips,control group)were treated with simple core decompression,including7cases of ARCO stage I and10cases of ARCO stage II.Harris scores,X-ray and magnetic resonance imaging were used to evaluate the surgical efficacy at1,3,6,9,12,18,24,30,36months after the operation.RESULTS AND CONCLUSION:The incision healed primarily in all patients,and no infection occurred.The follow-up lasted for1-3years(average2.5years).At the last follow-up,the Harris scores in both trial group and control group were significantly improved compared with the baseline(P<0.05);moreover,the Harris scores of ARCO stage I and II patients were significantly higher in the trial group than the control group(P<0.05).Collapse of the femoral head was observed in one hip(stage I)and one hip(stage II)of the trial group,and in three hips(stage I)and five hips(stage II)of the control group,and then hip arthroplasty was performed.The number of the patients developing collapse of the femoral head in the trial group was significantly less than that in the control group(P<0.05).Compared with simple core decompression,three-dimensional porous core decompression combined with autologous bone marrow transplantation is more adept to improve patient’s function and delay disease progression in the treatment of ARCO stage I and II early avascular necrosis of the femoral head.