Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44...Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.展开更多
目的探讨人工全髋关节置换(total hip arthroplasty,THA)治疗Crowe Ⅱ、Ⅲ型髋关节发育不良(developmental dysplasia of the hip,DDH)时采用自体股骨头结构性植骨的效果。方法2001年1月-2004年1月,收治23例29髋DDH继发骨性关节炎患者。...目的探讨人工全髋关节置换(total hip arthroplasty,THA)治疗Crowe Ⅱ、Ⅲ型髋关节发育不良(developmental dysplasia of the hip,DDH)时采用自体股骨头结构性植骨的效果。方法2001年1月-2004年1月,收治23例29髋DDH继发骨性关节炎患者。男3例3髋,女20例26髋;年龄43～65岁,平均52岁。单髋17例,双髋6例。Crowe分型:Ⅱ型17例20髋,Ⅲ型6例9髋。单侧患者双下肢不等长为(2.9±0.8)cm,术前Harris评分为(43.6±13.8)分。术中3例4髋采用标准THA,其余患者在关节置换同时采用自体股骨头结构性植骨重建髋臼旋转中心。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间4～7年,平均5.6年。术后12个月X线片示植骨块均已愈合。末次随访时单侧患者双下肢不等长为(0.9±0.2)cm,Harris评分为(86.3±6.4)分,与术前比较差异均有统计学意义(P<0.05)。X线片示髋臼和股骨假体无移位,未见植骨块有明显移位和吸收塌陷征象。结论CroweⅡ、Ⅲ型DDH行THA时采用自体股骨头结构性植骨有利于恢复髋臼旋转中心,提供良好髋臼固定,并增加骨盆骨量。展开更多
文摘Objective： To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell （BMCs） infusion. Methods： 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results： No complications were observed after the operation. Before operation, there were stage Ⅰ of femoral head necrosis in 8 hips, stage Ⅱin 15 hips, stage Ⅲin 14 hips, stage Ⅳ in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage Ⅰ in 6 hips, stage Ⅱin 13 hips, stage Ⅲin 13 hips, stage Ⅳ in 7 hips, stage Ⅴ in 4 hips. The mean preoperative Harris hip score was 58 （ 46-89 ）, and improved to 86 （ 70-94 ） postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30 %. Conclusions ： Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.
文摘目的探讨人工全髋关节置换(total hip arthroplasty,THA)治疗Crowe Ⅱ、Ⅲ型髋关节发育不良(developmental dysplasia of the hip,DDH)时采用自体股骨头结构性植骨的效果。方法2001年1月-2004年1月,收治23例29髋DDH继发骨性关节炎患者。男3例3髋,女20例26髋;年龄43～65岁,平均52岁。单髋17例,双髋6例。Crowe分型:Ⅱ型17例20髋,Ⅲ型6例9髋。单侧患者双下肢不等长为(2.9±0.8)cm,术前Harris评分为(43.6±13.8)分。术中3例4髋采用标准THA,其余患者在关节置换同时采用自体股骨头结构性植骨重建髋臼旋转中心。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间4～7年,平均5.6年。术后12个月X线片示植骨块均已愈合。末次随访时单侧患者双下肢不等长为(0.9±0.2)cm,Harris评分为(86.3±6.4)分,与术前比较差异均有统计学意义(P<0.05)。X线片示髋臼和股骨假体无移位,未见植骨块有明显移位和吸收塌陷征象。结论CroweⅡ、Ⅲ型DDH行THA时采用自体股骨头结构性植骨有利于恢复髋臼旋转中心,提供良好髋臼固定,并增加骨盆骨量。
