CAJ | 학술논문

目的评估非细胞型组织工程骨联合钛棒微创植入治疗早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效.方法 2003年1月至2006年6月,确诊早期ONFH 32例(42髋);国际骨循环研究学会分期:I期8髋,ⅡA期11髋,ⅡB期13髋,ⅡC期10髋;在X线透视定位及关节镜监视下,经皮微创行髓芯减压,植入非细胞型组织工程骨,并钛棒支撑股骨头软骨下骨质.术后6、12、24、36个月时随访,临床评价包括:疼痛评分、Harris评分、X线片病情评价及以全髋关节置换作为失败终点的生存率分析.结果患者术后疼痛及Harris评分指数各时间段(不含第24个月)之间前后比较及与术前比较,差异均有统计学意义.X线分期比较,术后16个月1例ⅡB期进展为ⅡC期,术后24个月2例ⅡC髋病变加重,股骨头塌陷,30个月后行全髋关节置换术.术后患者总改善率88.1%,与激素应用有关的Ⅱ期病变3年生存率最低;I期病变治疗改善率最佳,ⅡA期、ⅡB期改善率次之,ⅡC期改善率最低,无变化及加重患者均为激素性ONFH病例.结论非细胞型组织工程骨联合钛捧微创植入,除对ONFH ⅡC期激素性病变疗效改善极差应慎重选择外,对Ⅰ-ⅡC期病变可有效防止股骨头塌陷.
목적 평고비세포형조직공정골연합태봉미창식입치료조기고골두배사(osteonecrosis of the femoral head,ONFH)적림상료효.방법 2003년1월지2006년6월,학진조기ONFH 32례(42관);국제골순배연구학회분기:I기8관,ⅡA기11관,ⅡB기13관,ⅡC기10관;재X선투시정위급관절경감시하,경피미창행수심감압,식입비세포형조직공정골,병태봉지탱고골두연골하골질.술후6、12、24、36개월시수방,림상평개포괄:동통평분、Harris평분、X선편병정평개급이전관관절치환작위실패종점적생존솔분석.결과 환자술후동통급Harris평분지수각시간단(불함제24개월)지간전후비교급여술전비교,차이균유통계학의의.X선분기비교,술후16개월1례ⅡB기진전위ⅡC기,술후24개월2례ⅡC관병변가중,고골두탑함,30개월후행전관관절치환술.술후환자총개선솔88.1%,여격소응용유관적Ⅱ기병변3년생존솔최저;I기병변치료개선솔최가,ⅡA기、ⅡB기개선솔차지,ⅡC기개선솔최저,무변화급가중환자균위격소성ONFH병례.결론 비세포형조직공정골연합태봉미창식입,제대ONFH ⅡC기격소성병변료효개선겁차응신중선택외,대Ⅰ-ⅡC기병변가유효방지고골두탑함.
Objective To evaluate the clinical effect of non-cellular tissue engineering bone com-bined with Titanium rod in the treatment of early stage osteonecrosis of the femordl head (ONFH).Methods From January 2003 to June 2006,32 early stage ONFH patients (48 hips) were included.Based on Associa-tion Research Circulation Osseous staging,8 hips were rated as stage Ⅰ,11 as ⅡA,13 as ⅡB,and 10 as ⅡC.By X-ray and arthroscopy navigation.the percutaneous core decompression was performed and the non-cellu-lar tissue engineering bone was grafted.combined with Titanium rod supporting the sclerotin under the carti-lage.The patients were followed up at the 6th,12th,24th and 36th month postoperatively.Clinical evalua-tions included:pain score.Harris hip score,the change of the X-ray images and the evaluation of the ratio of total hip arthroplasty (THA).Results The pain score and the Harris hip score had a statistical significance by the comparison between the preoperative and postoperative patients and the comparison among the pa-tients at each time point postoperatively (except the 24th month).Sixteen months postoperatively,one stage ⅡB hip progressed to ⅡC;the femoral head of two hips collapsed 24 months postoperatively and were per-formed THA finally.The patients who had accepted the therapy of the hormone had a worst survival rate;the total improvement rate was 88.1%.The patients of stage Ⅰ had the best improvement rate,and the patients of stage ⅡC were the worst.All patients who had a hormone-using history had no changes or even got worse.Conclusion Non-cellular tissue engineering bone combined with Titanium rod minimally invasive grafting is effective in the treatment of early ONFH,from stage Ⅰ to ⅡC,except ⅡC patients who had a history of the use of the hormone,and it can prevent the femoral head from collapsing.