中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (36): 5746-5752.doi: 10.3969/j.issn.2095-4344.0555

• 骨组织构建 bone tissue construction • 上一篇    下一篇

围塌陷期股骨头坏死的联合治疗：髓芯减压、自体髂骨打压植骨、异体腓骨植入与中药

曾  平1，赖崇荣2，李金溢1，杜敏东1，何凯毅1，孙  斌1，黄肖华1，秦  刚1   

  1. (1广西中医药大学第一附属医院仙葫院区骨二科，广西壮族自治区南宁市  530200；2广西中医药大学，广西壮族自治区南宁市  530001)
  • 收稿日期:2018-06-25 出版日期:2018-12-28 发布日期:2018-12-28
  • 作者简介:曾平，女，1971年生，湖南省邵阳市人，汉族，2008年广州中医药大学毕业，博士，主任医师，主要从事中医药防治股骨头坏死研究。
  • 基金资助:

    国家自然科学基金项目(81360551)；国家中医药管理局项目(JDZX2015272)；广西壮族自治区中医药管理局科技项目(GZMZ1206)；广西壮族自治区医疗卫生重点科研项目(2011053)

Core decompression, autologous iliac bone graft, allogeneic fibular fixation combined with traditional Chinese medicine for treatment of peri-collapse stage osteonecrosis of the femoral head

Zeng Ping1, Lai Chongrong2, Li Jinyi1, Du Mindong1, He Kaiyi1, Sun Bin1, Huang Xiaohua1, Qin Gang1   

  1. (1Second Department of Orthopedics, Xianhu Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530200, Guangxi Zhuang Autonomous Region, China; 2Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China)
  • Received:2018-06-25 Online:2018-12-28 Published:2018-12-28
  • About author:Zeng Ping, MD, Chief physician, Second Department of Orthopedics, Xianhu Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530200, Guangxi Zhuang Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81360551; State Administration of Traditional Chinese Medicine, No. JDZX2015272; the Traditional Chinese Medicine Administration of Science and Technology Project of Guangxi Zhuang Autonomous Region, No. GZMZ1206; the Medical and Health Research Project of Guangxi Zhuang Autonomous Region, No. 2011053

PDF

244

摘要：

文章快速阅读：

文题释义：
腓骨植入：是基于髓芯减压的基础上联合植骨，结合股骨颈骨折内固定术演变而来，其原理是经减压孔道，
植入腓骨起支撑作用，重建或维持股骨头外形，为坏死区的修复创造一个相对有利环境。
围塌陷期股骨头坏死：ARCO Ⅳ期为股骨头坏死的晚期，股骨头塌陷，头臼不匹配，关节间隙狭窄，软骨退变，已失去了保髋价值；ARCOⅡ期和Ⅲ期是保髋的最佳时期，何伟教授将临床有无疼痛及疼痛的时间与影像学ARCO分期与JIC分型相结合，提出了“围塌陷期”的新概念，具体为ARCO Ⅱ期，JIC分型 B、C 型；ARCO Ⅲ期，塌陷<4 mm、疼痛<6个月，为股骨头坏死保髋手术适应证选择提供了新思路。
摘要
背景：单纯保髋手术治疗股骨头坏死的远期效果不理想，目前临床采用保髋手术结合中药治疗获得了良好的疗效。
目的：探讨髓芯减压、自体髂骨打压植骨、异体腓骨植入联合山甲活血补肾经验方治疗围塌陷期股骨头坏死的临床疗效。
方法：采用髓芯减压、自体髂骨打压植骨、异体腓骨植入治疗24例(28髋)围塌陷期股骨头坏死患者，术后配合口服山甲活血补肾经验方9-12个月，全部病例均获得1年以上随访。临床评价以Harris评分为标准，影像学评价以ARCO分期及JIC分型为标准，以股骨头出现塌陷>4 mm为终点观察指标，使用Kaplan-meier生存曲线分析股骨头生存率。
结果与结论：①24例患者获得12-78个月随访(平均26.95个月)，末次随访Harris评分明显高于治疗前     (P < 0.05)，末次随访时股骨头总生存率为79%；②根据治疗前ARCO分期坏死范围进行分层，ⅡB、ⅡC、ⅢB、ⅢC型股骨头生存率比较差异有显著性意义(100%，100%，100%，67%，P <0.05)；③根据治疗前ARCO分期塌陷程度进行分层，A型、B型股骨头生存率比较差异有显著性意义(77%，67%，P < 0.05)；④根据治疗前正位、蛙位JIC分型进行分层，B、C1、C2型股骨头生存率比较差异无显著性意义(100%、81%，100%，P > 0.05)；⑤结果表明，髓芯减压、自体髂骨打压植骨、异体腓骨植入联合山甲活血补肾经验方治疗围塌陷期股骨头坏死，可促进股骨头坏死修复，近期临床疗效确切，更适合于ARCO分期ⅡB、ⅡC及Ⅲ期塌陷程度< 2 mm的股骨头坏死患者。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程
ORCID: 0000-0001-9042-7283(曾平)

关键词: 股骨头坏死, 腓骨植入, 髓芯减压, 山甲活血补肾方, 国家自然科学基金, 组织构建

Abstract:

BACKGROUND: Long-term effect of simple hip-preserving surgery for osteonecrosis of the femoral head (ONFH) is not ideal. The combination of hip-preserving surgery and traditional Chinese medicine has achieved satisfactory curative effectiveness.
OBJECTIVE: To explore the clinical effect of core decompression, autologous iliac bone graft, and allogeneic fibular fixation combined with Shanjia Huoxue Bushen Recipe in the treatment of peri-collapse stage ONFH.
METHODS: Twenty-four patients (28 hips) with peri-collapse stage ONFH were treated with core decompression, autologous iliac bone graft and allogeneic fibular fixation. After operation, all the patients received oral administration of Shanjia Huoxue Bushen Recipe for 9-12 months, and were followed-up for more than 1 year. The clinical evaluation was based on the Harris scores; the imaging evaluation was based on ARCO stage and JIC classification; the femoral head collapsed > 4 mm was the end point; the survival rate of femoral head was analyzed by Kaplan-meier survival curve.
RESULTS AND CONCLUSION: All patients were followed up for 12-78 months (26.95 months averagely). The Harris score at the last follow-up was significantly higher than that at baseline (P < 0.05), and the total survival rate of femoral head was 79%. There were significant differences in the survival rate of femoral head among IIB, IIC, IIIA, IIIB and IIIC in ARCO stage (according to the necrosis range) (100%, 100%, 100%, 67%, P < 0.05). There was significant difference in the survival rate of femoral head between A and B in ARCO classification (according to collapse degree). There was no significant difference in the survival rate of femoral head among B, C1 and C2 in JIC classification (100%, 81%, 100%, P > 0.05). To conclude, core decompression, autologous iliac bone graft, allogeneic fibular fixation combined with Shanjia Huoxue Bushen Recipe can be used to treat peri-collapse period ONFH, which can promote the repair of necrotic femoral head, short-term clinical effect is exact and more suitable for IIB, IIC and III in ARCO stage when femoral head collapsed < 2 mm in ONFH patients.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words:  Femur Head Necrosis, Decompression, Surgical, Drugs, Chinese Herbal, Bone Transplantation, Tissue Engineering

中图分类号: