Porous bioceramic beta-tricalcium phosphate for treatment of osteonecrosis of the femoral head

doi:10.3969/j.issn.2095-4344.2014.16.003

Abstract

Abstract:

BACKGROUND: It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage.

OBJECTIVE: To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head.

METHODS: From January to December 2008, 58 patients (88 hips) who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. All patients were evaluated both clinically and radiographically at postoperative 3, 6, 12 months and annually. Functional improvement was assessed with the Harris hip score.

RESULTS AND CONCLUSION: Among these patients, 56 patients (85 hips) were followed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excellent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points (P < 0.001). All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role in the lateral column of the necrotic area, and further prevent collapse, which is suitable for patients with osteonecrosis of the femoral head, especially for those with joint preservation.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: femur head necrosis, bone transplantation, bone substitutes, treatment outcome

CLC Number:

R318

Sun Wei, Li Zi-rong, Gao Fu-qiang, Shi Zhen-cai, Wang Bai-liang, Guo Wan-shou . Porous bioceramic beta-tricalcium phosphate for treatment of osteonecrosis of the femoral head[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(16): 2474-2479.

Figures/Tables 1

2.1 纳入患者随访分析 58例(88髋)中56例患者(85髋)获得随访2-5年，所有患者均在治疗后24个月进行疗效评估。 2.2 手术时间和出血量患者均可耐受手术，手术时间为15-40 min，平均(29.7±8.9) min，出血量为50-150 mL，平均(80.0±27.8) mL。 2.3 患髋功能的改善情况参考Harris评分系统，优55髋，良12髋，可5髋，差13髋。有效率为84.7%(72/85)，优良率78.8%(67/85)，其中保头失败中有11髋实施人工关节置换，其中ARCO分期Ⅲb 6髋，Ⅲa 4髋，Ⅱc 1髋；CJFH分型L3型8髋，L2型2髋，L1型1髋。患者治疗前的Harris评分平均为(61.2±18.9)分，治疗后平均为(85.3±17.2)分，平均提高了24.1分(P < 0.001)。 2.4 髋关节影像学观察结果表现稳定，无进一步塌陷，股骨头内成骨明显，植骨区密度增高，6个月左右磷酸三钙多孔生物陶瓷与周围骨组织结合紧密，并逐步被自体骨替代，替代时间为1-1.5年。 2.5 不良反应及并发症有3例伤及股外侧皮神经，1例双髋出现异位骨化并发症。 2.6 典型病例分析患者男，50岁，激素性股骨头坏死，左髋疼痛2年余伴跛行及活动受限入院，入院检查X射线片正位及蛙式位示左侧股骨头坏死，已塌陷，关节面欠平整(图1A)，蛙式位(图1B)示典型的新月征，关节面塌陷约3 mm，诊断为ARCO分期为Ⅲb，术前CT(图1C)示左侧股骨头内坏死灶面积较大，软骨下骨不连续，股骨头内吸收区。 CJFH分型L3，左侧Harris评分治疗前为71.2分。经股骨头保存自身关节手术治疗植入磷酸三钙多孔生物陶瓷60个月后，正位X射线显示股骨头内成骨明显，股骨头较术前无进一步塌陷(图1D)，蛙式位显示股骨头新月征消失，股骨头内密度增高，见明显成骨(图1E)，左侧Harris评分治疗后为95.1分。"

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