中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (18): 3311-3317.doi: 10.3969/j.issn.2095-4344.2013.18.012

• 细胞与组织移植 cell and tissue transplantation • 上一篇    下一篇

同种异体腓骨植入治疗股骨头坏死132髋2.5年随访

尧  浩，扈文海，李会杰，刘思源   

  1. 河北医科大学第三医院骨病科，河北省石家庄市  050051
  • 收稿日期:2012-09-16 修回日期:2012-10-18 出版日期:2013-04-30 发布日期:2013-04-30
  • 通讯作者: 扈文海，主任医师，教授，硕士研究生导师，河北医科大学第三医院骨病科，河北省石家庄市 050051 huwenhai95@163.com
  • 作者简介:尧浩★，男，1986年生，湖北咸宁崇阳人，汉族，河北医科大学在读硕士，主要从事股骨头坏死与骨肿瘤方面的研究。 yaohao1986@126.com

Allogeneic fibular implantation for the treatment of femoral head necrosis:  Clinical observation of 132 hips during 2.5 years follow-up

Yao Hao, Hu Wen-hai, Li Hui-jie, Liu Si-yuan   

  1. Department of Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang  050051, Hebei Province, China
  • Received:2012-09-16 Revised:2012-10-18 Online:2013-04-30 Published:2013-04-30
  • Contact: Hu Wen-hai, Chief physician, Professor, Master’s supervisor, Department of Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China huwenhai95@163.com
  • About author:Yao Hao★, Studying for master’s degree, Department of Orthopedics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China yaohao1986@126.com

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612

被引次数

13

摘要：

背景：股骨头坏死保存自身关节的治疗方法较多。带血管游离腓骨植入后需要长期卧床、创伤大、出血多，植入后并发症多；金属钽棒置入对后续人工关节置换带来困难。
目的：探讨带孔同种异体腓骨植入治疗股骨头坏死的近期临床疗效及其适应证。
方法：纳入股骨头坏死患者中的103例(132髋)，平均43.2岁(20-70岁)，根据Steinberg分期：Ⅰ期13髋，Ⅱ期53髋，Ⅲa期40髋，Ⅲb期26髋。应用股骨头钻孔减压联合带孔同种异体腓骨植入。植入前、后均采用Harris评分系统对髋关节功能评估；植入后3，6，12，24个月摄正侧位X射线平片，观察股骨头修复情况以及坏死进展并加以分析。
结果与结论：所有患者均随访2.0-2.5 年，平均2.3年。植入前Harris平均68.5(64.7±7.8)分，植入后提高至平均91.4(91.0±2.6)分，治疗前后差异有显著性意义(P < 0.05)。随访患者24个月时候的X射线平片示106髋有明显改善，7髋无变化，10髋恶化，9髋失败，总有效率为85.6%，恶化及失败髋关节均为SteinbergⅢ b期。所有患者均无严重并发症。说明钻孔减压联合带孔同种异体腓骨植入治疗成年人早期股骨头坏死效果显著，尤其适用于青壮年SteinbergⅠ期，Ⅱ期，Ⅲa期。

关键词: 器官移植, 器官移植临床实践, 股骨头坏死, 金属钽棒, 植入, 髓芯减压, 同种异体, 髋关节功能, 腓骨, 移植, 带孔, 血管游离

Abstract:

BACKGROUND: Many treatment methods that keep their joints have been used to treat femoral head necrosis. Blood vessel free fibular grafting induces need long-term bed rest, larger damage, blood loss and complications during rehabilitation. Tantalum rod was difficult to artificial hip joint replacement in later.
OBJECTIVE: To evaluate the recent clinical effect and indications of allogeneic fibula implantation with core for the treatment of femoral head necrosis.
METHODS: A total of 103 patients (132 hips) with femoral head necrosis were involved, aged 43.2 (20-70) years. According to Steinberg stage, 13 hips at stageⅠ, 53 hips at stage Ⅲ, and 40 hips at stage Ⅲa, 26 hips at stage Ⅲb. The combination of core decompression and allogeneic fibular implantation with hole was used to treat the femoral head necrosis. Harris scores were used to evaluate hip function pre-operation and post-operation. The X-ray films were taken at 3, 6, 12 and 24 months after implantation to observe the repair progress of femoral head necrosis and to analyze the results.
RESULTS AND CONCLUSION: All patients were followed-up for 2.0-2.5 years (means 2.3 years). Preoperative Harris score was (64.7±7.8) points, 68.5 points on average, and postoperative score was (91.0±2.6) points, 91.4 points on average. There was significant difference between preoperative and postoperative Harris scores (P < 0.05). After 24 months, the X-ray film of all patients showed 106 hips improved, 7 hips unchanged, 10 hips deterioration and 9 hips failed, the total effective rate was 85.6%, and all the deterioration and failed patients were at stage IIIb. All patients had no any complications. The curative effect of core decompression and allogeneic fibula implantation with hole for the treatment of femoral head necrosis is confirmed, especially for Steinberg Ⅰ period, Ⅱ period and Ⅲ a period of young patients.

Key words: organ transplantation, clinical practice in organ transplantation, femoral head necrosis, metal tantalum rod, implantation, core decompression, allogeneic, hip joint function, fibula, transplantation, perforated, free vessels

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