髓芯减压联合陶瓷骨植入治疗中早期股骨头坏死的临床研究

本文旨在评估髓芯减压联合陶瓷骨植入治疗股骨头坏死的临床疗效, 并与单纯髓芯减压手术进行对比. 纳入第一作者所在医院骨科自2015年1月至2017年8月收治的早期股骨头坏死患者32例(40髋). 采用随机数表法将患髋随机分为A、B两组: A组20例, 行单纯髓芯减压术; B组20例, 行髓芯减压联合陶瓷骨植入手术. 术后每3个月通过影像学检查及查体对患者进行随访, 依据X线片结果将影像学分为进展及稳定两个等级. 髋关节功能评分采取Harris评分(Harris Hip Score, HHS). 记录两组数据并进行对比分析. 所有手术均顺利, 无围手术期严重并发症发生. 单纯髓芯减压组12髋(60.0%）影像学稳定, 髓芯减压联合陶瓷骨植入组18髋(90.0%)影像学稳定, 二者具有统计学差异(p=0.032). 两组术后HHS均较术前明显提高, 髓芯减压联合陶瓷骨植入组术后平均HSS为92.1分, 显著优于单纯髓芯减压组(HHS: 82.2, p=0.008). 按照HHS评分等级, 髓芯减压联合陶瓷骨植入组髋关节功能优良率为95.0%, 显著高于单纯髓芯减压组(70.0%, p=0.046). 髓芯减压联合陶瓷骨植入手术的临床疗效优于单纯髓芯减压手术, 可以作为治疗早中期股骨头坏死的有效方法.

Clinical study on the effect of osteonecrosis of femoral head by core decompression in combination with biological ceramics implantation

The current study was aimed to evaluate the clinical efficacy of core decompression in combination with biological ceramics implantation on osteonecrosis of the femoral head (ONFH), as compared with that of the decompression alone. Thirty-two patients (40 hips) with early ONFH were admitted and the study lasted from January 2015 to August 2017. The hips were randomly divided into group A and group B. Twenty hips in group A underwent simple core decompression and patients in group B underwent core decompression in combination with biological ceramics implantation. Patients were followed up every 3 months by imaging and physical examination. According to the X-ray test, the imaging results were divided into grades of progress and stability. The hip function was assessed using the Harris Hip Score (HHS). All operations were successful and no serious complication occurred in perioperative period. For imaging studies, 12 hips (60.0%) in group A were stable, and there were 18 hips (90.0%) in group B, with statistical difference (p=0.032). Postoperative HHS of the two groups was significantly improved compared with pre-surgery results. The postoperative mean HHS of group B was 92.1 points, which is significantly higher than that of group A (HHS: 82.2, p=0.008). Based on the HHS, the excellent and good rate of hip joint function in group B was 95.0%, significantly higher than that in group A (70.0%, p=0.046). Core decompression combined with biological ceramics implantation is more effective than simple core decompression and can be used as an effective method for early and mid-term ONFH