辅助人工髋关节治疗股骨头缺血性坏死的实验研究

Experimental studies on the treatment of avascular necrosis of the femoral head by the assistant artificial hip joint implantation

目的通过动物实验探讨一种新的非限制性支撑装置-辅助人工髋关节对早期股骨头缺血性坏死的治疗效果。方法采用骨龄成熟杂交犬32只,用液氮冷冻法建立股骨头缺血性坏死动物模型。实验组手术植入辅助人工髋关节,减轻、替代股骨头负重,对照组不与处理。结果4,12周实验组(累计观察数分别为19,15)和对照组(累计观察数分别为11,9)股骨头高度比分别为0.871±0.007,0.870±0.006和0.871±0.007,0.869±0.008(单位),差异无统计学意义。24周,对照组的实验侧股骨头不规则密度增高伴囊性变,呈现出不同程度的塌陷,实验组(累计观察数为10)和对照组(累计观察数为6)股骨头高度比分别为0.868±0.006,0.747±0.046(t=6.905,P=0.009)。48周,对照组股骨头大部分塌陷,髋关节呈现骨性关节炎改变,股骨头高度比降低,实验组(累计观察数为5)和对照组(累计观察数为3)股骨头高度比分别为0.871±0.007,0.637±0.091(t=4.446,P=0.046)。相反实验组24周及48周手术侧股骨头仅出现不同程度的密度降低,未见囊性变及股骨头塌陷。结论辅助人工髋关节能有效地维持髋关节空间构形,减少或替代股骨头负重,对液氮冷冻所至的早期股骨头缺血性坏死具有治疗作用。

Aim To investigate the therapeutic efficacy of assistant artificial hip joint (AAHJ) implantation on the early avascular necrosis of the femoral head (ANFH).Methods Thirty two skeletal mature hybrid dogs were divided into experimental group of 20 dogs and control group of 12 dogs at random. The animal model of avascular necrosis of femoral head was adopted by the freezing of liquid nitrogen. AAHJ was implanted into the hips of the experimental group. On the contrary, nothing was implanted into the hips of the control group.Results The height rates of femoral head were 0.871±0.007 and 0.871±0.007 in the experimental group and control group at 4 weeks respectively, 0.870±0.006 and 0.869±0.008 in the two groups at 12 weeks respectively, without statistical differences. The height rates of femoral head were 0.868±0.006 and 0.747±0.046 in the two groups respectively at 24 weeks. The femoral head on the experimental side in the control group sank differently with the density increased irregularly and cystic degeneration. The height rates of femoral head were 0.871±0.007 and 0.637±0.091 in the two groups at 48 weeks respectively, with a significant difference between the two groups (t=4.46,P=0.046). The femoral head of the control group mostly sank, coxa showed the symptom of bone arthrositis, and the height rate of femoral head decreased. At 24 and 48 weeks, the density of femoral head in the experimental group decreased without cystic degeneration and femoral head sinking.Conclusion The implantation of AAHJ, which is not only reducing the loading of the femoral head, but also changing the pathological progress of ANFH, is an available method to improve the repair of the early ANFH.