中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
18期
86-92
,共7页
尧浩%扈文海%李会杰%刘思源
堯浩%扈文海%李會傑%劉思源
요호%호문해%리회걸%류사원
器官移植%器官移植临床实践%股骨头坏死%金属钽棒%植入%髓芯减压%同种异体%髋关节功能%腓骨%移植%带孔%血管游离
器官移植%器官移植臨床實踐%股骨頭壞死%金屬鐽棒%植入%髓芯減壓%同種異體%髖關節功能%腓骨%移植%帶孔%血管遊離
기관이식%기관이식림상실천%고골두배사%금속단봉%식입%수심감압%동충이체%관관절공능%비골%이식%대공%혈관유리
organ transplantation%clinical practice in organ transplantation%femoral head necrosis%metal tantalum rod%implantation%core decompression%al ogeneic%hip joint function%fibula, transplantation%perforated%free vessels
背景:股骨头坏死保存自身关节的治疗方法较多.带血管游离腓骨植入后需要长期卧床、创伤大、出血多,植入后并发症多;金属钽棒置入对后续人工关节置换带来困难.
目的:探讨带孔同种异体腓骨植入治疗股骨头坏死的近期临床疗效及其适应证.
方法:纳入股骨头坏死患者中的103例(132髋),平均43.2岁(20-70岁),根据Steinberg分期:Ⅰ期13髋,Ⅱ期53髋,Ⅲa期40髋,Ⅲb期26髋.应用股骨头钻孔减压联合带孔同种异体腓骨植入.植入前、后均采用Harris评分系统对髋关节功能评估;植入后3,6,12,24个月摄正侧位X射线平片,观察股骨头修复情况以及坏死进展并加以分析.
结果与结论:所有患者均随访2.0-2.5年,平均2.3年.植入前Harris平均68.5(64.7±7.8)分,植入后提高至平均91.4(91.0±2.6)分,治疗前后差异有显著性意义(P<0.05).随访患者24个月时候的X射线平片示106髋有明显改善,7髋无变化,10髋恶化,9髋失败,总有效率为85.6%,恶化及失败髋关节均为SteinbergⅢ b期.所有患者均无严重并发症.说明钻孔减压联合带孔同种异体腓骨植入治疗成年人早期股骨头坏死效果显著,尤其适用于青壮年SteinbergⅠ期,Ⅱ期,Ⅲa期.
揹景:股骨頭壞死保存自身關節的治療方法較多.帶血管遊離腓骨植入後需要長期臥床、創傷大、齣血多,植入後併髮癥多;金屬鐽棒置入對後續人工關節置換帶來睏難.
目的:探討帶孔同種異體腓骨植入治療股骨頭壞死的近期臨床療效及其適應證.
方法:納入股骨頭壞死患者中的103例(132髖),平均43.2歲(20-70歲),根據Steinberg分期:Ⅰ期13髖,Ⅱ期53髖,Ⅲa期40髖,Ⅲb期26髖.應用股骨頭鑽孔減壓聯閤帶孔同種異體腓骨植入.植入前、後均採用Harris評分繫統對髖關節功能評估;植入後3,6,12,24箇月攝正側位X射線平片,觀察股骨頭脩複情況以及壞死進展併加以分析.
結果與結論:所有患者均隨訪2.0-2.5年,平均2.3年.植入前Harris平均68.5(64.7±7.8)分,植入後提高至平均91.4(91.0±2.6)分,治療前後差異有顯著性意義(P<0.05).隨訪患者24箇月時候的X射線平片示106髖有明顯改善,7髖無變化,10髖噁化,9髖失敗,總有效率為85.6%,噁化及失敗髖關節均為SteinbergⅢ b期.所有患者均無嚴重併髮癥.說明鑽孔減壓聯閤帶孔同種異體腓骨植入治療成年人早期股骨頭壞死效果顯著,尤其適用于青壯年SteinbergⅠ期,Ⅱ期,Ⅲa期.
배경:고골두배사보존자신관절적치료방법교다.대혈관유리비골식입후수요장기와상、창상대、출혈다,식입후병발증다;금속단봉치입대후속인공관절치환대래곤난.
목적:탐토대공동충이체비골식입치료고골두배사적근기림상료효급기괄응증.
방법:납입고골두배사환자중적103례(132관),평균43.2세(20-70세),근거Steinberg분기:Ⅰ기13관,Ⅱ기53관,Ⅲa기40관,Ⅲb기26관.응용고골두찬공감압연합대공동충이체비골식입.식입전、후균채용Harris평분계통대관관절공능평고;식입후3,6,12,24개월섭정측위X사선평편,관찰고골두수복정황이급배사진전병가이분석.
결과여결론:소유환자균수방2.0-2.5년,평균2.3년.식입전Harris평균68.5(64.7±7.8)분,식입후제고지평균91.4(91.0±2.6)분,치료전후차이유현저성의의(P<0.05).수방환자24개월시후적X사선평편시106관유명현개선,7관무변화,10관악화,9관실패,총유효솔위85.6%,악화급실패관관절균위SteinbergⅢ b기.소유환자균무엄중병발증.설명찬공감압연합대공동충이체비골식입치료성년인조기고골두배사효과현저,우기괄용우청장년SteinbergⅠ기,Ⅱ기,Ⅲa기.
@@@@BACKGROUND:Many treatment methods that keep their joints have been used to treat femoral head necrosis. Blood vessel free fibular grafting induces need long-term bed rest, larger damage, blood loss and complications during rehabilitation. Tantalum rod was difficult to artificial hip joint replacement in later. @@@@OBJECTIVE:To evaluate the recent clinical effect and indications of al ogeneic fibula implantation with core for the treatment of femoral head necrosis. @@@@METHODS:A total of 103 patients (132 hips) with femoral head necrosis were involved, aged 43.2 (20-70) years. According to Steinberg stage, 13 hips at stageⅠ, 53 hips at stage Ⅲ, and 40 hips at stage Ⅲa, 26 hips at stageⅢb. The combination of core decompression and al ogeneic fibular implantation with hole was used to treat the femoral head necrosis. Harris scores were used to evaluate hip function pre-operation and post-operation. The X-ray films were taken at 3, 6, 12 and 24 months after implantation to observe the repair progress of femoral head necrosis and to analyze the results. @@@@RESULTS AND CONCLUSION:Al patients were fol owed-up for 2.0-2.5 years (means 2.3 years). Preoperative Harris score was (64.7±7.8) points, 68.5 points on average, and postoperative score was (91.0±2.6) points, 91.4 points on average. There was significant difference between preoperative and postoperative Harris scores (P<0.05). After 24 months, the X-ray film of al patients showed 106 hips improved, 7 hips unchanged, 10 hips deterioration and 9 hips failed, the total effective rate was 85.6%, and al the deterioration and failed patients were at stage IIIb. Al patients had no any complications. The curative effect of core decompression and al ogeneic fibula implantation with hole for the treatment of femoral head necrosis is confirmed, especial y for Steinberg Ⅰperiod, Ⅱ period and Ⅲ a period of young patients.
