围塌陷期股骨头坏死的联合治疗:髓芯减压、自体髂骨打压植骨、异体腓骨植入与中药

Core decompression, autologous iliac bone graft, allogeneic fibular fixation combined with traditional Chinese medicine for treatment of peri-collapse stage osteonecrosis of the femoral head

背景:单纯保髋手术治疗股骨头坏死的远期效果不理想,目前临床采用保髋手术结合中药治疗获得了良好的疗效。目的:探讨髓芯减压、自体髂骨打压植骨、异体腓骨植入联合山甲活血补肾经验方治疗围塌陷期股骨头坏死的临床疗效。方法:采用髓芯减压、自体髂骨打压植骨、异体腓骨植入治疗24例(28髋)围塌陷期股骨头坏死患者,术后配合口服山甲活血补肾经验方9-12个月,全部病例均获得1年以上随访。临床评价以Harris评分为标准,影像学评价以ARCO分期及JIC分型为标准,以股骨头出现塌陷>4 mm为终点观察指标,使用Kaplan-meier生存曲线分析股骨头生存率。结果与结论:(1)24例患者获得12-78个月随访(平均26.95个月),末次随访Harris评分明显高于治疗前(P <0.05),末次随访时股骨头总生存率为79%;(2)根据治疗前ARCO分期坏死范围进行分层,ⅡB、ⅡC、ⅢB、ⅢC型股骨头生存率比较差异有显著性意义(100%,100%,100%,67%,P <0.05);(3)根据治疗前ARCO分期塌陷程度进行分层,A型、B型股骨头生存率比较差异有显著性意义(77%,67%,P <0.05);(4)根据治疗前正位、蛙位JIC分型进行分层,B、C1、C2型股骨头生存率比较差异无显著性意义(100%、81%,100%,P> 0.05);(5)结果表明,髓芯减压、自体髂骨打压植骨、异体腓骨植入联合山甲活血补肾经验方治疗围塌陷期股骨头坏死,可促进股骨头坏死修复,近期临床疗效确切,更适合于ARCO分期ⅡB、ⅡC及Ⅲ期塌陷程度<2 mm的股骨头坏死患者。

BACKGROUND:Long-term effect of simple hip-preserving surgery for osteonecrosis of the femoral head(ONFH)is not ideal.The combination of hip-preserving surgery and traditional Chinese medicine has achieved satisfactory curative effectiveness.OBJECTIVE:To explore the clinical effect of core decompression,autologous iliac bone graft,and allogeneic fibular fixation combined with Shanjia Huoxue Bushen Recipe in the treatment of peri-collapse stage ONFH.METHODS:Twenty-four patients(28 hips)with peri-collapse stage ONFH were treated with core decompression,autologous iliac bone graft and allogeneic fibular fixation.After operation,all the patients received oral administration of Shanjia Huoxue Bushen Recipe for 9-12 months,and were followed-up for more than 1 year.The clinical evaluation was based on the Harris scores;the imaging evaluation was based on ARCO stage and JIC classification;the femoral head collapsed>4 mm was the end point;the survival rate of femoral head was analyzed by Kaplan-meier survival curve.RESULTS AND CONCLUSION:All patients were followed up for 12-78 months(26.95 months averagely).The Harris score at the last follow-up was significantly higher than that at baseline(P<0.05),and the total survival rate of femoral head was 79%.There were significant differences in the survival rate of femoral head among IIB,IIC,IIIA,IIIB and IIIC in ARCO stage(according to the necrosis range)(100%,100%,100%,67%,P<0.05).There was significant difference in the survival rate of femoral head between A and B in ARCO classification(according to collapse degree).There was no significant difference in the survival rate of femoral head among B,C1 and C2 in JIC classification(100%,81%,100%,P>0.05).To conclude,core decompression,autologous iliac bone graft,allogeneic fibular fixation combined with Shanjia Huoxue Bushen Recipe can be used to treat peri-collapse period ONFH,which can promote the repair of necrotic femoral head,short-term clinical effect is exact and more suitable for IIB,IIC and III in ARCO stage when femoral head collapsed<2 mm in ONFH patients.