自体富血小板血浆联合陶瓷骨植骨治疗早期股骨头坏死短期效果评估

Evaluation of short-term efficacy of autologous platelet-rich plasma combined with ceramic bone grafting in the treatment of early femoral head necrosis

【目的】评估自体富血小板血浆(platelet rich plasma,PRP)联合组织工程化陶瓷骨植骨治疗早期股骨头坏死短期效果。【方法】2017年1月至2018年1月在西安市红会医院搜集早期股骨头坏死(国际骨循环学会分期Ⅰ~Ⅱ为标准)确诊患者70例,按照随机分组对照试验方法分为两组,治疗组患者35例,采用自体PRP联合陶瓷骨植骨术;对照组患者35例,实行单纯陶瓷骨植骨术。比较两组患者术前、术后3、6及12个月髋关节功能评分(Harris评分)及疼痛视觉模拟评分(visual analogue scale,VAS),搜集并分析两组患者术前、术后6个月及12个月影像学资料。【结果】所有患者均获得随访,治疗组1例患者因车祸致股骨粗隆间骨折行全髋关节置换(终止随访),对照组1例患者因摔伤致股骨颈骨折行全髋关节置换,3人股骨头塌陷(终止随访)。剩余患者比较,治疗组Harris评分由术前(65.67±5.38)分提升至术后12个月(81.55±2.90)分,VAS评分由术前(5.47±0.50)分降至术后12个月(1.58±0.55)分;对照组Harris评分由术前(64.87±4.30)分提升至术后12个月(79.77±2.57)分,VAS评分由术前(5.64±0.55)分降至术后12个月(1.93±0.62)分。术后12个月治疗组髋关节Harris评分(81.55±2.90)分与对照组(79.77±2.57)分比较,差异具有统计学意义(P<0.05);术后12个月治疗组VAS评分(1.58±0.55)分与对照组(1.93±0.62)分比较,差异具有统计学意义(P<0.05)。【结论】自体PRP联合陶瓷骨植骨治疗早期股骨头坏死具有良好前景。

【Objective】To evaluate the short-term efficacy of autologous platelet-rich plasma(PRP)combined with tissue engineered ceramic bone grafting in the treatment of early femoral head necrosis.【Methods】From January 2017 to January 2018,70 patients with early femoral head necrosis(ARCO stagingⅠ~Ⅱas standard)in Xi’an Honghui hospital were divided into two groups according to the randomized controlled trial method.In the treatment group,35 patients were treated with autologous PRP combined with ceramic bone grafting.In the control group,35 patients underwent simple ceramic bone grafting.The hip function scores(Harris score)and visual analogue scale(VAS)were compared before surgery,3 months,6 months and 12 months after surgery.The imaging data of the two groups were collected and analyzed before operation,6 months and 12 months after operation.【Results】All the patients were followed up.One patient in the treatment group underwent total hip arthroplasty due to femoral intertrochanteric fracture in a car accident(terminating follow-up).In the control group,one person underwent total hip arthroplasty due to femoral neck fracture,and three patients suffered from femoral head collapses(terminating followup).The remaining patients were compared.The Harris score in the treatment group was increased from(65.67±5.38)before surgery to(81.55±2.90)12 months after operation,and the VAS score was reduced from(5.47±0.50)before surgery to(1.58±0.55)12 months after operation.The Harris score in the control group was increased from(64.87±4.30)before surgery to(79.77±2.57)12 months after surgery,and the VAS score was decreased from(5.64±0.55)before surgery to(1.93±0.62)12 months after operation.The Harris score in the treatment group(81.55±2.90)was significantly different from that(79.77±2.57)in the control group 12 months after operation(P<0.05),and the VAS score in the treatment group(1.58±0.55)was significantly different from that(1.93±0.62)in the control group(P<0.05).【Conclusion】Autologous PRP combined with ceramic bone grafting has a good prospect for early femoral head necrosis.