CAJ | 학술논문

背景：单纯髓芯减治疗早期股骨头缺血性坏死对软骨下骨支撑不够，增加了骨折及塌陷的风险。股方肌骨块的植入不仅可以提供很好的生物学支撑，也会增加坏死区域的再血管化，从而达到修复股骨头坏死的作用。目的：比较髓芯减压股方肌骨块植入和髓芯减压骨浆植入治疗早期股骨头缺血性坏死的早期临床效果。方法：选取2009年1月至2012年1月在郑州大学第一附属医院骨科进行治疗的早期股骨头坏死患者83例92髋，按治疗方法分为髓芯减压股方肌骨块植入组及髓芯减压骨浆植入组。其中髓芯减压股方肌骨块植入组37例43髋于坏死区注射自体骨转移及骨诱导活性材料，髓芯减压骨浆植入组患者46例49髋则注入骨粉。结果与结论：治疗后1年，2组患者 Harris评分均比治疗前显著提高(P <0.05)，髓芯减压骨浆植入组患者Harris评分低于髓芯减压股方肌骨块植入组(P <0.05)。治疗后3年髓芯减压股方肌骨块植入组患者X射线评分显著高于髓芯减压骨浆植入组(P <0.05)。提示与髓芯减压骨浆植入相比，髓芯减压股方肌骨块植入能够更有效地防止股骨头塌陷，改善关节功能及延缓股骨头坏死进程。
배경：단순수심감치료조기고골두결혈성배사대연골하골지탱불구，증가료골절급탑함적풍험。고방기골괴적식입불부가이제공흔호적생물학지탱，야회증가배사구역적재혈관화，종이체도수복고골두배사적작용。목적：비교수심감압고방기골괴식입화수심감압골장식입치료조기고골두결혈성배사적조기림상효과。방법：선취2009년1월지2012년1월재정주대학제일부속의원골과진행치료적조기고골두배사환자83례92관，안치료방법분위수심감압고방기골괴식입조급수심감압골장식입조。기중수심감압고방기골괴식입조37례43관우배사구주사자체골전이급골유도활성재료，수심감압골장식입조환자46례49관칙주입골분。결과여결론：치료후1년，2조환자 Harris평분균비치료전현저제고(P <0.05)，수심감압골장식입조환자Harris평분저우수심감압고방기골괴식입조(P <0.05)。치료후3년수심감압고방기골괴식입조환자X사선평분현저고우수심감압골장식입조(P <0.05)。제시여수심감압골장식입상비，수심감압고방기골괴식입능구경유효지방지고골두탑함，개선관절공능급연완고골두배사진정。
BACKGROUND:Core decompression may provide insufficient support for the subchondral bone in the treatment of early avascular necrosis of the femoral head and increase the risk of fracture and colapse. Quadratus femoris implantation cannot only provide good biological support, but also promote the revascularization at necrotic regions, thus repairing the necrosis of femoral head. OBJECTIVE: To compare the clinical effects of core decompression with bone paste implantation and core decompression with quadratus femoris implantation on early and middle-stage avascular necrosis of the femoral head. METHODS:Eighty-three patients with early avascular necrosis of the femoral head (92 hips) admitted at the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, China, from January 2009 to January 2012 were enroled and divided into groups of core decompression with bone paste implantation (46 cases, 49 hips) and core decompression with quadratus femoris implantation (37 cases, 43 hips) that were respectively injected with bone meal and autogenous bone and osteoinductive materials. RESULTS AND CONCLUSION: Al involved patients were folowed up. After 1 year of treatment, Harris scores in the two groups were both increased (P < 0.05). But the Harris score of core decompression with bone paste implantation group was lower than that of core decompression with quadratus femoris implantation group (P < 0.05). After 3 years of treatment, X-ray scores in the core decompression with quadratus femoris implantation group were significantly higher than those in the core decompression with bone paste implantation group (P < 0.05). These findings indicate that compared with core decompression with bone paste implantation, core decompression with quadratus femoris implantation is better to prevent femoral head colapse, improve hip function and delay the process of osteonecrosis of the femoral head.