ACD联合同种异体骨植骨治疗早期股骨头坏死初期报告

目的探讨改良髓芯减压（advanced core decompression，ACD）联合同种异体骨植骨治疗早期股骨头坏死的早期疗效。方法自2015年6月至2015年10月应用ACD联合同种异体骨植骨的方法治疗早期股骨头坏死56例92髋，男48例，女8例，年龄23～50岁，中位年龄35岁，其中单侧20例，双侧36例。根据术前MRI检查分期，ARCO分期（国际骨循环研究会分期）Ⅰ期9髋（Ⅰa 5髋，Ⅰb 3髋，Ⅰc 1髋），Ⅱ期83髋（Ⅱa 3髋，Ⅱb 47髋，Ⅱc 33髋），其中酒精性42例70髋，激素性7例11髋，特发性7例11髋。手术方法为应用9 mm钻头髓芯减压后，使用扩张式双刃铰刀，有效去除坏死骨，使用同种异体骨填充软骨下骨空腔并打压填充空腔。术后3个月禁止负重，而后扶拐部分负重行走3个月，逐步恢复弃拐行走。术前术后评价应用VAS评分、Harris评分、X线及CT、MRI评价进行统计学分析。结果术后患者均获随访，随访时间10～26个月（平均22个月），Harris评分较术前明显提高，由平均（72.5±4.3）分提升为平均（85.2±10.2）分（t=8.75，P<0.05），疼痛VAS评分明显降低，由平均（6.33±0.67）分降为平均（2.73±2.22）分（t=12.23, P<0.05）。至随访结束，Harris评分优良率为73.9%。结论应用改良髓芯减压联合同种异体骨植骨治疗早期股骨头坏死的早期结果优良，可有效改善功能，缓解疼痛，临床效果满意，远期效果有待进一步长期随访。

英文摘要:

Objective To discuss the early curative effect of advanced core decompression combined with allograft bone in the treatment of early stage ONFH. Methods From June 2015 to October 2015, a total of 56 patients (92 hips) with early stage ONFH (osteonecrosis of the femoral heads) were treated. Age ranged from 23 to 50 years (median 35). Unilateral femoral head necrosis occurred in 20 hips, and bilateral femoral head necrosis occurred in 72 hips. According to the standard of ACRO staging, 9 hips were in stageⅠ(Ⅰa 5 hips, Ⅰb 3 hips, Ⅰc 1 hips), 83 hips were in stageⅡ(Ⅱa 3 hips, Ⅱb 47 hips, Ⅱc 33 hips). Among all those patients, 42 were alcohol-related (70 hips), 7 were hoemone-related (11 hips), 7 were idiopathic-related (11 hips). Surgical technique: after decompression using 9 mm diameter cannalated drill bit, use the X-Ream expandable reamer into the drilling channel to debride the dead bone as much as possible. Finally the the surgically created bone defect and channel were backfilled and tamped using allograft bone. After surgery, patients use crutches to walk without bearing any weight for 3 months, after which they were allowed to resume full activities gradually. The curative effect was analyzed according to VAS score、Harris hip score、X-Ray、CT and MRI before and after surgery. Results All the involved 56 patients (92 hips) were followed up for 10～26 months postoperatively. 42 of them obtained excellent and good results, showing the pain disappearance and free activities. The Harris Hip Score increased prominently from preoperative mean (72.5±4.3) points to postoperative mean (85.2±10.2) points, with significant difference (P<0.05). The VAS score decreased prominently from preoperative mean (6.33±0.67) points to postoperative mean (2.73±2.22) points. The rate of excellent and good was 73.9%. Conclusion Experiment findings indicate that advanced core decompression combined with allograft bone has good curative effect in the treatment of early stage ONFH in the short term, and further studies are needed to observe the long term curative effect.

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