髓芯减压联合骨形成蛋白活性诱导棒植入术治疗早期股骨头坏死的效果

Core decompression combined with BMP activity inducing rod implantation for early femoral head necrosis

目的探讨髓芯减压联合骨形成蛋白(BMP)活性诱导棒植入术治疗早期股骨头坏死的效果。方法回顾性分析2018年6月至2022年6月收治的116例早期股骨头坏死患者,按照不同的手术方式分为髓芯减压联合BMP活性诱导棒组(BMP组)和同种异体骨组。BMP组60例,采用髓芯减压联合BMP活性诱导棒植入术治疗。同种异体骨组56例,采用髓芯减压联合同种异体骨打压植骨术治疗。对比两组患者术前、术后6个月和术后1年的髋关节Harris评分、疼痛视觉模拟评分(VAS)的差异,并对患者术后1年疗效和股骨头存活率进行比较。结果所有患者均获得随访,两组患者术前VAS评分、Harris评分差异无统计学意义(P>0.05),术后6个月、1年时两组患者VAS评分、Harris评分均显著改善,且BMP组优于同种异体骨组,差异有统计学意义(P<0.05)。术后1年时,BMP组Harris髋关节评分优良率高于同种异体骨组,差异有统计学意义(P<0.05);BMP组股骨头存活率高于同种异体骨组,差异有统计学意义(P<0.05)。结论髓芯减压联合BMP活性诱导棒植入术治疗早期股骨头坏死早期具有疗效,能够加速诱导新骨生成,提高新骨质量,为股骨头提供生物力学支撑,有效避免股骨头塌陷,且生物相容性好、能够在体内降解吸收,值得在临床上推广。

Objective To investigate the effect of core decompression combined with bone-morphogenetic proteins(BMP)activity inducing rod implantation in the treatment of early-stage femoral head necrosis.Methods Retrospective analysis of 116 patients with early-stage femoral head necrosis from June 2018 to June 2022 were divided into core decompression combined with BMP activity inducing rod group(BMP group)and allograft bone group.Sixty cases in the BMP group were treated with core decompression combined with implantation of BMP-activated induced rods,and 56 cases in the allograft group were treated with core decompression combined with bone grafting of the allograft bone by punching and compression.The differences in hip Harris scores and visual analogue scores(VAS)of pain between the two groups at preoperative,6 months postoperative and 1 year postop⁃erative,and the patient treatment response and femoral head survival rate at 1 year postoperative were compared.Results All patients were followed-up,and the difference between the preoperative VAS score and Harris score of the two groups was not statistically significant(P>0.05),and the VAS score and Harris score of the two groups were significantly improved at 6 months and 1 year after operation,and the BMP group was better than the allograft bone group,with significant difference(P<0.05).At 1 year after surgery,the Harris hip score excellence rate of the BMP group was higher than that of the allograft bone group,and the difference was statistically significant(P<0.05);the femoral head survival rate of the BMP group was higher than that of the allograft bone group,and the difference was statistically significant(P<0.05).Conclusions Core decompression combined with BMP activity induced rod implantation was effective in the treatment of early femoral head necrosis,which accelerated the induction of new bone formation,improved the quality of new bone,provided biomechanical support for the femoral head,and effectively avoided femoral head collapse.Moreover,it has good biocompatibility and couldbe degraded and absorbed in the body,which is worthy of clinical promotion.