中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (6): 883-887.doi: 10.3969/j.issn.2095-4344.2017.06.011

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

髓芯减压联合β-磷酸三钙生物陶瓷治疗早期非创伤性股骨头坏死

何盛茂,林荔军,王成强,李  奇
  

  1. 南方医科大学珠江医院骨科中心,广东省广州市  510282
  • 收稿日期:2017-01-20 出版日期:2017-02-28 发布日期:2017-03-16
  • 通讯作者: 李奇,博士,博士生导师,教授,主任医师,南方医科大学珠江医院骨科中心,广东省广州市 510282
  • 作者简介:何盛茂,男,1981年生,南方医科大学在读硕士,主治医师,主要从事关节外科临床研究。
  • 基金资助:

    广东省省级科技计划项目(2014A020212668);课题名称:滑膜成纤维样细胞中HIF-1α-RANKL/OPG通路在假体无菌松动中作用研究

Core decompression combined with beta-tricalcium phosphate bioceramics for early non-traumatic osteonecrosis of the femoral head

He Sheng-mao, Lin Li-jun, Wang Cheng-qiang, Li Qi
  

  1. Orthopedic Center, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
  • Received:2017-01-20 Online:2017-02-28 Published:2017-03-16
  • Contact: Li Qi, M.D., Doctoral supervisor, Professor, Chief physician, Orthopedic Center, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
  • About author:He Sheng-mao, Studying for master’s degree, Attending physician, Orthopedic Center, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
  • Supported by:

    the Guangdong Provincial Science and Technology Program, No. 2014A020212668

摘要:

文章快速阅读:

 

文题释义:
股骨头坏死
:结合国际骨循环研究会及美国骨科医师学会的建议,将股骨头坏死定义为:股骨头血供中断或受损,引起骨细胞及骨髓成分死亡及随后的修复,继而导致股骨头结构改变,股骨头塌陷,关节功能障碍的疾病。临床上主要根据患者髋关节疼痛、活动受限,髋关节创伤、长期使用肾上腺皮质激素、酒精中毒等病史,结合X射线、MRI、核素扫描结果做出诊断。
生物陶瓷:是指用作特定的生物或生理功能的一类陶瓷材料,即直接用于人体或与人体直接相关的生物、医用、生物化学等陶瓷材料。作为生物陶瓷材料,需具备如下条件:生物相容性、力学相容性、与生物组织有优异的亲和性、抗血栓、灭菌性并具有很好的物理? 化学稳定性?

背景:国内外关于β-磷酸三钙生物陶瓷基础研究报道比较多,其用于治疗股骨头坏死的报道少见。
目的:分析髓芯减压联合β-磷酸三钙生物陶瓷治疗ARCOⅠ/Ⅱ/ⅢA非创伤性股骨头坏死的近期疗效。
方法:采用髓芯减压合并β-磷酸三钙生物陶瓷植入治疗ARCOⅠ/Ⅱ /ⅢA非创伤性股骨头坏死患者12例16髋。治疗前后进行Harris评分及影像学观察。以末次随访的Harris评分或影像学显示病情有进展或发生严重并发症的前次Harris评分为最终评分。
结果与结论:①所有病例未出现骨折、感染等并发症,均获得随访,平均时间19个月(11-30个月);②治疗前Harris评分为(73.61±3.70)分,治疗后为(84.88±7.11)分,差异有非常显著性意义(P < 0.001);③疗效:优5例5髋、良5例9髋、中1例1髋、差1例1髋,优良率为88%(14/16);④治疗后1例ⅡC期及1例ⅢA期股骨头坏死出现影像学进展,后者改行全髋置换,余病例影像学均未见明显进展;⑤结果表明,髓芯减压联合β-磷酸三钙生物陶瓷治疗ARCOⅠ/Ⅱ /ⅢA非创伤性股骨头坏死可获得良好的近期疗效。

关键词: 生物材料, 骨生物材料, 生物陶瓷, β-三磷酸钙, 股骨头坏死, 髓芯减压

Abstract:

BACKGROUND: There are numerous laboratory reports concerning β-tricalcium phosphate (β-TCP)
bioceramics; however, its application in the treatment of osteonecrosis of the femoral head (ONFH) is rarely reported.
OBJECTIVE: To analyze the short-term efficacy of core decompression combined with β-TCP bioceramics in the treatment of ARCO I/II /IIIA non-traumatic ONFH.
METHODS: Twelve patients (16 hips) suffered from ARCO I/II /IIIA non-traumatic ONFH were treated by core decompression combined with β-TCP implantation. The Harris hip scores (HHS) and radiological observation were performed before and after treatment. The HHS at the last follow-up or the HHS prior to the radiographs showing deterioration or severe complication occurrence was recorded.
RESULTS AND CONCLUSION: All patients were followed up for 19 months averagely (11-30 months) and no fracture, infection and other complications occurred. The HHS significantly increased from (73.61±3.70) to (84.88±7.11) points after treatment (P < 0.001). The postoperative outcome was excellent in five cases with five hips, good in five cases with nine hips, mild in one case with one hip, poor in one case with one hip, and the excellent and good rate was 87.5% (14/16). The radiographs of only one case of ARCO IIC and one case of ARCO IIIA showed deterioration, and the latter was given the total hip arthroplasty. These results indicate that the core decompression combined with β-TCP implantation achieve short-term efficacy for ARCO I/II /IIIA non-traumatic ONFH.

Key words: Femur Head Necrosis, Decompression, Surgical, Calcium Phosphates, Tissue Engineering

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