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组织工程化骨结合改良髓芯减压技术治疗早中期股骨头坏死中期疗效研究 被引量:5

The medium-term clinical efficacy of autogenous bone,allogeneic bone and bone morphogenetic protein-2 in the avascular necrosis of the femoral head
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摘要 目的探讨改良髓芯减压技术结合组织工程化自体骨、异体骨、骨形态发生蛋白-2(BMP-2)复合物治疗早中期股骨头坏死的中期疗效。方法武汉市第四医院行髓芯减压结合复合自体骨、异体骨、BMP-2复合物打压植骨的国际骨循环研究会(ARCO)分期Ⅱ期、ⅢA股骨头坏死患者25例(44髋),其中男18例,女7例;年龄(43.4±15.3)岁(19~64岁)。患者获得术后4~6年的随访,摄髋部前后位、蛙式侧位X线片,了解股骨头坏死修复及进展情况;通过髋关节功能Harris评分评估临床疗效。应用SPSS 22.0统计软件进行分析。结果末次随访Harris评分[(78.6±12.9)分]较术前[(66.2±12.7)分]明显改善,差异有统计学意义(t=5.960,P<0.001),总体优良率70.5%。ARCO分期ⅡA、ⅡB末次随访Harris评分优良率86.4%(19/22),ARCO分期ⅡC、ⅢA Harris评分优良率59.1%(13/22),40岁以下(≤40岁)7例12髋,髋关节保存率83.3%,40岁以上18例32髋,髋关节保存率68.8%。结论组织工程化自体骨、异体骨、BMP-2复合物结合改良髓芯减压技术治疗早中期股骨头坏死可有效改善患髋功能,在一定程度上可以延缓股骨头坏死进程,中期随访疗效满意,尤其是针对ARCO分期ⅡA、ⅡB患者以及40岁以下年轻患者。 Objective To evaluate the medium-term clinical efficacy of autogenous bone,allogeneic bone and bone morphogenetic protein-2 with core decompression in the treatment of osteonecrosis of the femoral head(ONFH).Methods Thirty-five patients(44 hips)with stageⅡorⅢA of ONFH according to the system of the association research circulation osseous(ARCO)were included in this study.All the patients underwent core decompression with implantation of the mixture of autogenous bone,allogeneic bone and bone morphogenetic protein-2.The mean age at surgery was(19-64)(43.4±15.3)years and the mean period of follow-up 5.2(4-6)years.X-ray films were taken at the follow-ups.Harris scores system was recorded before and after operation to evaluate clinical effects of surgery.Statisticalanalysis of data using the statistical product and service solutions 22.0 software.Results At the last follow-up,postoperative Harris hip scores(78.6±12.9)were significantly higher than those(66.2±12.7)before operation(t=5.96,P<0.01)and the rate of excellent and good results was 70.5%.In the patients of ARCOⅡA andⅡB,the rate of excellent and good results was 86.4%,and that was 59.1%in the patients of ARCOⅡC andⅢA.The hip survival rate was 83.3%in patients(12 hips)under 40 years of age,and 68.8%in patients(32 hips)over 40 years of age.Conclusion The implantation of the mixture of autogenous bone,allogeneic bone and bone morphogenetic protein-2 with core decompression appears to confer benefits in the treatment of in stagesⅡ-ⅢA ONFH at medium-term follow-up.It seems that the patients in stages ARCOⅡA-ⅡB or those under 40 years of age can get better results by this treatment of ONFH.
作者 程文俊 王俊文 左伟 肖志宏 徐海军 焦竞 肖飞 Cheng Wenjun;Wang Junwen;Zou Wei;Xiao Zhihong;Xu Haijun;Jiao Jing;Xiao Fei(Department of Orthopaedics,Wuhan Fourth Hospital,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)
出处 《中华实验外科杂志》 CAS CSCD 北大核心 2019年第5期954-957,共4页 Chinese Journal of Experimental Surgery
基金 湖北省研究与开发计划项目(2011BCB028) 湖北省卫生厅青年科技人才项目(QJX2010-46).
关键词 股骨头坏死 减压术 骨移植 组织工程 骨形态发生蛋白-2 Femoral head necrosis Decompressive surgery Bone grafting Tissue engineering Recombinant human morphogenetic protein-2
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