关节镜下髓芯减压BAM骨诱导人工骨治疗股骨头缺血性坏死的效果

网络出版时间：2015-10-13网络出版地址：http://www.cnki.net/kcms/detail/52.5012.R.20151013.1254.028.html

刘刚

(咸阳市中心医院 骨一科， 陕西 咸阳712000)

[摘要]目的： 探究关节镜下髓芯减压BAM骨诱导人工骨治疗股骨头缺血性坏死(INFH)的临床效果。方法： 选INFH患者71例(44髋)，分为观察组(关节镜辅助下行髓芯减压植入BAM骨诱导人工骨手术)和对照组(行常规髓芯减压术)，比较两组患者术前、术后3月及6月Harris评分，术后6月Ficat分期的Harris评分，比较两组INFH患者术后6个月临床有效率及观察组INFH患者不同Ficat分期手术有效率。结果： 术后3月和6月时，观察组INFH患者Harris评分明显高于对照组(P<0.01)；观察组INFH患者术后6月的Ficat Ⅰ、Ⅱ、Ⅲ期 Harris评分高于对照组(P<0.01)，术后6个月临床有效率高于对照组(P=0.023)；观察组INFH患者Ⅰ期或Ⅱ期手术有效率高于Ⅲ期(P<0.05)。结论： 关节镜下髓芯减压BAM骨诱导人工骨术的临床疗效优于常规髓芯减压术。

[关键词]股骨头缺血性坏死； 关节镜； BAM骨诱导人工骨； 髋关节； 髓芯减压； Harris评分

[中图分类号]R687.3[文献标识码] A

Clinical Efficacy of Core Decompression Combined with Implantation

of Artificial BAM Bone by Using Arhtroscopy in the Treatment

of Ischemic Necrosis of Femoral Head

LIU Gang

(DepartmentofOrthopedics,CentralHospitalofXianyangCity,Xianyang712000,Shaanxi,China)

Abstract[] Objective: To investigate the clinical efficacy of core decompression combined with implantation of artificial BAM bone in the treatment of ischemic necrosis of femoral head (INFH).Methods: Seventy-one patients with INFH were divided into observation group (accepted core decompression combined with implantation of artificial BAM bone) and control group (accepting regular core decompression). Harris score was compared between the two groups before treatment, 3 and 6 months after treatment. Clinical efficacy of pateints with different Ficat staging was compared 6 months after treatment. Results: Harris score of observation group was obviously higher than that of control group at 3, 6 months after treatment, the difference was statistically significant (P<0.01). Harris score of patients with Ficat stage Ⅰ, Ⅱ, Ⅲ in observation group were higher than that of control group, the difference was statistically significant (P<0.01). The clinical efficiacy of observation group was higher than the control group (P=0.023). Surgical efficacy of patients with stage Ⅱ or Ⅰ of observation group was higher than patients with stage Ⅲ (P<0.05).Conclusions: The clinical efficacy of core decompression combined with implantation of artificial BAM bone in the treatment of INFH is better than regular core decompression.

[Key words] ischemic necrosis of femoral head; arthroscopy; artificial BAM bone; core decompression; Harris score

股骨头缺血性坏死(ischemic necrosis of femoral head,INFH)是由于股骨头血供障碍导致股骨头及软骨的变性、坏死、塌陷，可造成髋关节功能丧失[1]。INFH多发于30~50岁中年人[2]，早期症状不明显或伴有轻微疼痛，易被患者及医生忽略而错过最佳治疗时机，引起股骨头塌陷和继发性骨关节炎，致残率较高[3]。常规治疗INFH的方法有髓芯减压术、骨移植术和髋关节置换术[4]，随着近年材料科学的发展和微创外科技术的进步，手术治疗INFH的治愈率和手术成功率大幅提高。本研究通过关节镜下髓芯减压术联合BAM骨诱导人工骨手术和常规髓芯减压手术治疗INFH，报告如下。

1对象与方法

1.1　对象

2013年1月~2014年6月接受治疗的INFH患者71例(44髋)，在患者知情同意后分为观察组(关节镜辅助下行髓芯减压植入BAM骨诱导人工骨手术)和对照组(常规髓芯减压术)。……