微创保髋治疗非创伤性股骨头缺血坏死术后2年的临床效果

Clinical effect of minimally invasive hip preservation in the treatment of nontraumatic osteonecrosis of the femoral head after operation 2 years

目的观察非创伤性股骨头坏死早期行微创髓芯减压、β-磷酸三钙生物陶瓷结合富血小板血浆(PRP)填充植骨治疗的临床效果。方法收集2014年4月至2016年6月我科确诊的非创伤性股骨头坏死患者13例(16髋),手术采用可扩张球形创减压器械行股骨头髓芯减压,彻底清除股骨头死骨后行β-磷酸三钙生物陶瓷颗粒及陶瓷棒联合自体PRP混合植入治疗。治疗前、后进行髋关节VAS评分、髋关节Harris评分及通过影像学观察病变进展。结果术后2年,患者的VAS评分低于术前,髋关节Harris评分高于术前(P<0.05)。1例ARCOⅡC期患者术后24个月时进展至ARCOⅢ期,但患者拒绝二次手术治疗,仍在保守治疗中。术后12个月时,2例ARCOⅠ期患者影像学图片显示股骨头病变进展至ARCOⅡA期后逐渐稳定,至末次随访时病变无明显进展。结论微创髓芯减压结合β-磷酸三钙生物陶瓷及PRP混合植骨治疗早期非创伤性股骨头坏死,能改善术后2年髋关节疼痛症状,延缓病变进展,推迟人工关节置换时间,且手术具有微创性。

Objective To observe the clinical effect of minimally invasive core decompression, β-tricalcium phosphate bioceramics combined with platelet rich plasma(PRP) filling and bone grafting in the early stage of nontraumatic osteonecrosis of the femoral head. Methods From April 2014 to June 2016, 13 cases(16 hips) of nontraumatic osteonecrosis of the femoral head confirmed in our department were collected. The expandable spherical decompression instrument was used to decompress the core of the femoral head. After the femoral head was completely removed, β-tricalcium phosphate bioceramic particles and ceramic rods combined with self-made PRP were implanted. Before and after treatment, VAS score and Harris score of hip joint were carried out, and the pathological progress was observed by imaging. Results At two years after operation, the VAS score of patients was lower than that before operation, while Harris score of hip joint was higher than that before operation(P<0.05). One case of ARCO Ⅱ C stage advanced to ARCO Ⅲ stage 24 months after operation, but the patient refused the second operation and was still in conservative treatment. At 12 months after the operation, the imaging images of 2 patients with ARCO Ⅰ stage showed that the lesions of femoral head gradually stabilized after advanced to ARCO Ⅱ A stage, and there was no significant progress at the last follow-up. Conclusion Minimally invasive core decompression combined with β-tricalcium phosphate bioceramics and PRP bone grafting in the treatment of early nontraumatic osteonecrosis of the femoral head can improve the symptoms of hip pain 2 years after operation, delay the progress of lesions and the time of artificial joint replacement, and has minimally invasive surgery.