目的探討髓芯減壓植骨術(shù)治療早、中期股骨頭缺血性壞死（avascular necrosis of the femoral head，ANFH）的遠(yuǎn)期療效。 方法回顧分析2000年1月－2006年12月采用髓芯減壓植骨術(shù)治療的87例（114髖）ANFH患者資料。其中男74例（97髖），女13例（17髖）；年齡20～56歲，平均38歲。酒精性54例（62.1%），激素性26例（29.9%），特發(fā)性7例（8.0%）。病程3～46個(gè)月，平均18個(gè)月。Ficat分期：Ⅰ期16髖，Ⅱ期68髖，Ⅲ期30髖。根據(jù)手術(shù)前后Harris髖關(guān)節(jié)功能評(píng)分變化和Ficat分期改變進(jìn)行臨床評(píng)價(jià)和影像學(xué)評(píng)價(jià)；以改行人工關(guān)節(jié)置換術(shù)為終點(diǎn)，采用Kaplan-Meier法進(jìn)行生存分析。 結(jié)果87例均獲隨訪，隨訪時(shí)間5年～11年10個(gè)月，平均8年9個(gè)月。患者Harris髖關(guān)節(jié)功能評(píng)分由術(shù)前（73.13 ± 7.17）分提高至末次隨訪時(shí)的（81.59 ± 13.23）分，差異有統(tǒng)計(jì)學(xué)意義（t= —9.318，P=0.000）?？偱R床成功率為69.3%（79/114），總影像學(xué)成功率為54.4%（62/114）。Kaplan-Meier生存分析提示總生存率為84.2%（96/114），F(xiàn)icat Ⅲ期生存率60.0%（18/30）顯著低于FicatⅠ期100%（16/16）和FicatⅡ期91.2%（62/68），差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.01）；FicatⅠ、Ⅱ期間比較差異無統(tǒng)計(jì)學(xué)意義（χ2=1.520，P=0.218）。 結(jié)論髓芯減壓植骨術(shù)是治療FicatⅠ、Ⅱ期（早期）ANFH的一種安全有效治療方法，術(shù)后遠(yuǎn)期臨床療效滿意；而對(duì)Ficat Ⅲ期（中期）患者遠(yuǎn)期臨床療效差。

引用本文： 劉德淮,陳前芬,陳源,劉云. 髓芯減壓植骨術(shù)治療早、中期股骨頭缺血性壞死的遠(yuǎn)期療效. 中國(guó)修復(fù)重建外科雜志, 2012, 26(10): 1165-1168. doi: 復(fù)制

1. 許偉華, 楊述華, 馮勇, 等. 多孔鉭棒植入治療股骨頭壞死的適應(yīng)證及臨床療效觀察. 中國(guó)骨與關(guān)節(jié)外科, 2010, 3(1): 28-32.
2. Korompilias AV, Beris AE, Lykissas MG, et al. Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery, 2011, 31(3): 223-228.
3. Tetik C, Basar H, Bezer M, et al. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc, 2011, 45(5): 326-334.
4. Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop, 2011, 35(4): 489-495.
5. Drescher W, Pufe T, Smeets R, et al. Avascular necrosis of the hip-diagnosis and treatment. Z Orthop Unfall, 2011, 149(2): 231-242.
6. 方志, 陳曦, 劉樹平. 髓芯減壓結(jié)合自體皮質(zhì)支撐骨及松質(zhì)顆粒骨植骨治療成人股骨頭缺血性壞死. 中國(guó)修復(fù)重建外科雜志, 2010, 24(3): 266-269.
7. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int, 2011, 21(2): 206-210.
8. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
10. 顏景濤, 趙德偉, 王本杰, 等. 股骨頭骨折后并發(fā)股骨頭缺血性壞死的治療. 中華顯微外科雜志, 2008, 31(5): 344-346.
11. Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
12. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8): 1583-1588.
13. 趙德偉, 崔大平. 股骨頭缺血性壞死修復(fù)與再造的長(zhǎng)期隨訪觀察. 中國(guó)矯形外科雜志, 2008, 16(7): 481-484.
14. 金永利, 畢鄭鋼, 楊成林. 帶血管蒂肌骨瓣轉(zhuǎn)移與髓芯鉆孔減壓植骨治療股骨頭缺血壞死的療效比較. 內(nèi)蒙古民族大學(xué)學(xué)報(bào): 自然科學(xué)版, 2011, 26(1): 86-89.
15. 劉宇鵬, 趙德偉, 王衛(wèi)明, 等. 股骨頭缺血性壞死修復(fù)重建術(shù)后血運(yùn)重建的觀察. 中國(guó)實(shí)用醫(yī)藥, 2011, 6(16): 26-27.
16. 竇亞棟, 趙德偉, 郭林, 等. 帶蒂大轉(zhuǎn)子骨瓣修復(fù)股骨頭生物力學(xué)研究. 中國(guó)骨與關(guān)節(jié)外科, 2010, 3(1): 68-72.
17. Watters TS, Browne JA, Orlando LA, et al. Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head. J Surg Orthop Adv, 2011, 20(3): 158-167.
18. Garrigues GE, Aldridge JM 3rd, Friend JK, et al. Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation. Microsurgery, 2009, 29(5): 342-345.
19. 趙德偉, 崔大平. 股骨頭缺血性壞死修復(fù)與再造的長(zhǎng)期隨訪觀察. 中國(guó)矯形外科雜志, 2008, 16(7): 481-484.
20. 許偉華, 楊述華, 李寶興, 等. 同種異體皮質(zhì)骨支撐骨籠聯(lián)合自體骨移植治療股骨頭壞死. 中國(guó)修復(fù)重建外科雜志, 2009, 23(5): 527-529.
  1. 1. 許偉華, 楊述華, 馮勇, 等. 多孔鉭棒植入治療股骨頭壞死的適應(yīng)證及臨床療效觀察. 中國(guó)骨與關(guān)節(jié)外科, 2010, 3(1): 28-32.
  2. 2. Korompilias AV, Beris AE, Lykissas MG, et al. Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery, 2011, 31(3): 223-228.
  3. 3. Tetik C, Basar H, Bezer M, et al. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc, 2011, 45(5): 326-334.
  4. 4. Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop, 2011, 35(4): 489-495.
  5. 5. Drescher W, Pufe T, Smeets R, et al. Avascular necrosis of the hip-diagnosis and treatment. Z Orthop Unfall, 2011, 149(2): 231-242.
  6. 6. 方志, 陳曦, 劉樹平. 髓芯減壓結(jié)合自體皮質(zhì)支撐骨及松質(zhì)顆粒骨植骨治療成人股骨頭缺血性壞死. 中國(guó)修復(fù)重建外科雜志, 2010, 24(3): 266-269.
  7. 7. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int, 2011, 21(2): 206-210.
  8. 8. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br), 1985, 67(1): 3-9.
  9. 9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
  10. 10. 顏景濤, 趙德偉, 王本杰, 等. 股骨頭骨折后并發(fā)股骨頭缺血性壞死的治療. 中華顯微外科雜志, 2008, 31(5): 344-346.
  11. 11. Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
  12. 12. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8): 1583-1588.
  13. 13. 趙德偉, 崔大平. 股骨頭缺血性壞死修復(fù)與再造的長(zhǎng)期隨訪觀察. 中國(guó)矯形外科雜志, 2008, 16(7): 481-484.
  14. 14. 金永利, 畢鄭鋼, 楊成林. 帶血管蒂肌骨瓣轉(zhuǎn)移與髓芯鉆孔減壓植骨治療股骨頭缺血壞死的療效比較. 內(nèi)蒙古民族大學(xué)學(xué)報(bào): 自然科學(xué)版, 2011, 26(1): 86-89.
  15. 15. 劉宇鵬, 趙德偉, 王衛(wèi)明, 等. 股骨頭缺血性壞死修復(fù)重建術(shù)后血運(yùn)重建的觀察. 中國(guó)實(shí)用醫(yī)藥, 2011, 6(16): 26-27.
  16. 16. 竇亞棟, 趙德偉, 郭林, 等. 帶蒂大轉(zhuǎn)子骨瓣修復(fù)股骨頭生物力學(xué)研究. 中國(guó)骨與關(guān)節(jié)外科, 2010, 3(1): 68-72.
  17. 17. Watters TS, Browne JA, Orlando LA, et al. Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head. J Surg Orthop Adv, 2011, 20(3): 158-167.
  18. 18. Garrigues GE, Aldridge JM 3rd, Friend JK, et al. Free Vascularized Fibular Grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation. Microsurgery, 2009, 29(5): 342-345.
  19. 19. 趙德偉, 崔大平. 股骨頭缺血性壞死修復(fù)與再造的長(zhǎng)期隨訪觀察. 中國(guó)矯形外科雜志, 2008, 16(7): 481-484.
  20. 20. 許偉華, 楊述華, 李寶興, 等. 同種異體皮質(zhì)骨支撐骨籠聯(lián)合自體骨移植治療股骨頭壞死. 中國(guó)修復(fù)重建外科雜志, 2009, 23(5): 527-529.