[1]张宏军,刘又文,范克杰,等.微创减压植骨联合自体骨髓干细胞移植治疗股骨头坏死[J].中医正骨,2013,25(03):56-58.
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微创减压植骨联合自体骨髓干细胞移植治疗股骨头坏死()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期数:
2013年03期
页码:
56-58
栏目:
股骨头坏死
出版日期:
2013-03-20

文章信息/Info

作者:
张宏军刘又文范克杰梁国辉
河南省洛阳正骨医院,河南 洛阳 471002
关键词:
股骨头坏死 干细胞移植 骨髓干细胞 骨移植
摘要:
目的:探讨微创减压植骨联合自体骨髓干细胞移植治疗股骨头坏死的临床疗效。方法:采用微创病灶清除、打压植骨联合自体骨髓干细胞移植治疗股骨头坏死患者67例(85髋),男44例(53髋),女23例(32髋)。年龄18~50岁,中位数38岁。激素性24例,酒精性29例,外伤性9例,特发性5例。按照ARCO骨坏死分期标准,ⅠC期5髋,ⅡA期19髋,ⅡB期25髋,ⅡC期22髋,ⅢA期9髋,ⅢB期3髋,ⅢC期2髋。术后随访观察患髋关节功能及ARCO骨坏死分期。结果:①一般情况。本组患者手术时间30~70 min,中位数50 min; 切口长度6~10 cm,中位数8 cm; 术中出血量80~150 mL,中位数100 mL。所有患者的手术切口均甲级愈合,未发生感染及其他并发症。65例(82髋)获得12个月以上随访,失访的2例(3髋)患者失访前未发现髋关节功能异常,影像学检查示病变无进展。②Harris髋关节功能评分。术后12个月随访时患者的患髋疼痛、功能、活动范围评分及总分[(41.12±3.35)分,(43.42±5.63)分,(4.32±3.78)分,(86.42±9.74)分]均高于术前[(19.52±3.21)分,(34.87±5.23)分,(3.65±1.35)分,(62.21±7.71)分],差异有统计学意义(t=42.157,P=0.000; t=11.956,P=0.000; t=1.511,P=0.004; t=17.648,P=0.000)。③X线评价。术前ARCO分期为ⅡC期的2例(2髋)患者、ⅢA期1例(1髋)患者、ⅢB期1例(2髋)患者及ⅢC期2例(2髋)患者术后12个月X线片示植骨区股骨头密度不均,有囊性变,18个月后发展为Ⅳ期,其中5例(6髋)行全髋关节置换,1例(1髋)未行髋关节置换术,扶拐行走; 3例(5髋)由ⅡB期进展为ⅢA期,未行髋关节置换术。其余56例(70髋)术后12个月X线片示股骨头外形完整,无塌陷,病变区无密度不均和囊性变,坏死骨全部或大部被新生骨替代。结论:微创减压植骨联合自体骨髓干细胞移植治疗股骨头坏死近期疗效确切、创伤小,比较适用于ARCOⅡ期股骨头坏死患者的治疗。

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备注/Memo

备注/Memo:
基金项目:河南省科技厅攻关项目(09yy0068)
更新日期/Last Update: 2013-03-20