中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (43): 8159-8162.doi: 10.3969/j.issn.1673-8225.2011.43.043

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

非创伤性股骨头坏死69例83髋：带血管蒂臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨的修复

王亦进1，栾  舰1，崔学芬1，任跃兵2   

  1. 1青岛市市立医院东院骨科，山东省青岛市 266071
    2青岛大学医学院，山东省青岛市  266071
  • 收稿日期:2011-04-20 修回日期:2011-05-26 出版日期:2011-10-22 发布日期:2011-10-22
  • 作者简介:王亦进，男，1954年生，山东省高密市人，汉族，1982年潍坊医学院毕业，主任医师，主要从事关节、脊柱外科研究。 qdluanjian@hotmail.com

Efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head in 69 cases with 83 hips

Wang Yi-jin1, Luan Jian1, Cui Xue-fen1, Ren Yue-bing2   

  1. 1Department of Orthopedics, Qingdao Municipal Hospital, Qingdao  266071, Shandong Province, China
    2Medical School of Qingdao University, Qingdao  266071, Shandong Province, China
  • Received:2011-04-20 Revised:2011-05-26 Online:2011-10-22 Published:2011-10-22
  • About author:Wang Yi-jin, Chief physician, Department of Orthopedics, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China qdluanjian@hotmail.com

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摘要：

背景：目前成人股骨头非创伤性坏死的治疗方法较多，但远期疗效大多不肯定。
目的：观察带血管蒂臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨治疗非创伤性股骨头坏死的临床效果。
方法：采用彻底刮除病灶死骨、骨形态发生蛋白混合自体松质骨加带血管蒂的臀中肌骨瓣移植治疗非创伤性股骨头坏死69例83髋。股骨颈部的缺损用取自大转子的臀中肌骨瓣嵌入，不作内固定。治疗后定期复查髋正位X射线片。
结果与结论：患者随访12~120个月，患者治疗后的髋关节疼痛明显缓解或消失，关节活动度改善。根据中华医学会推荐的100分评分法进行评价，优48髋(58%)，良27髋(33%)，可6髋(7%)，差2髋(2%)，优良率为90%。提示带血管蒂的臀中肌骨瓣移植复合骨形态发生蛋白和自体松质骨治疗非创伤性股骨头坏死创伤小，能促进坏死骨修复。但远期疗效尚待进一步观察。

关键词: 肌骨瓣移植, 股骨头坏死, 非创伤性, 植骨, 骨形态发生蛋白

Abstract:

BACKGROUND: Currently, there are many methods for treatment of adult non-invasive femoral head necrosis, but their long-term efficacy is not sure.
OBJECTIVE: To evaluate the clinical efficacy of gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head. 
METHODS: Sixty-nine patients (83 hips) with non-traumatic osteonecrosis of the femoral head underwent thorough curettage and gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone. Defects in the femoral neck were implanted with gluteal muscle flap from the greater trochanter without fixation. After treatment, anteroposterior X-ray films of the hip were regularly reviewed.
RESULTS AND CONCLUSION: All the patients were followed up successfully for 12-120 months (average 48 months). The pain of the hip in all patients disappeared or mostly relieved after the operation. The motion of hip joint became better. According to the score of 100 points recommended by Chinese Medical Association, the surgical outcomes were excellent in 48 hips (58%), good in 27 hips (33%), fair in 6 hips (7%), and poor in 2 hips (2%). The good rate was 90%. The gluteus medius bone grafting with vascular pedicle combined with bone morphogenetic protein and autogenous cancellous bone for non-traumatic osteonecrosis of the femoral head can obtain mini-trauma, better recovery of necrotic bone and excellent clinical results. However, the long-term effects need further studies.

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