股骨头坏死的减压植骨联合唑来膦酸和富血小板血浆△

Decompression and bone autografting combined with local application of zoledronic acid and platelet-rich plasma for ear⁃ ly- stage femoral head necrosis

摘要:

［目的］探讨微创通道下股骨头减压植骨联合应用唑来膦酸和富血小板血浆（platelet rich plasm, PRP）治疗早期股骨头坏死的临床效果。［方法］回顾性分析 2017 年 1 月—2019 年 1 月收治的早期股骨头坏死 130 例（189 髋）患者的临床资料，随机分两组。其中 95 髋采用微创通道减压植骨联合局部应用唑来膦酸和 PRP（复合组），另外 94 髋仅单纯微创通道减压植骨（单纯组）。比较两组围手术期、随访及影像资料。［结果］两组患者均顺利完成手术，无严重并发症，两组手术时间、切口长度、术中失血量、术后引流量比较差异均无统计学意义（P>0.05）。两组患者均获随访 20~25 个月，平均（22.35±0.92）个月。至末次随访，保髋成功率复合组为 94/95（98.95%），单纯组为 90/94（95.74%），两组间差异无统计学意义（P=0.358）。复合组下地行走时间和完全负重活动均显著早于单纯组（P<0.05），术后 6 个月和末次随访时，复合组的 VAS 和 Harris 评分均显著优于单纯组（P<0.05）。影像方面，末次随访时复合组的股骨头坏死面积显著优于单纯组（P<0.05）。术后 6 个月和末次随访时，复合组的影像评级均显著优于单纯组（P<0.05）。 ［结论］微创通道下减压植骨联合局部应用唑来膦酸和 PRP 治疗早期股骨头坏死的效果显著优于单纯减压植骨。

Abstract:

[Objective] To investigate the clinical results of decompression and bone autografting under minimally invasive channel combined with local administration of zoledronic acid and platelet rich plasma (PRP) for early- stage femoral head necrosis. [Methods] From January 2017 to January 2019, 130 patients (189 hips) with early-stage femoral head necrosis were randomly divided into two groups. Of them, 95 hips were treated with minimally invasive channel decompression and bone autografting combined with zoledronic acid and PRP used locally (the combined group) , while the other 94 hips were treated with minimally invasive channel decompression bone grafting alone (simple group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious complications. There were no statistical differences in operative time, incision length, intraoperative blood loss and postoperative drainage between the two groups (P＞0.05) . The two groups of patients were followed up for 20~25 months, with an average of (22.35±0.92) months. At the last follow-up, the hip preservation success rate was 94/95 (98.95%) in the combined group and 90/94 (95.74%) in the simple group, and there was no significant difference between the two groups (P=0.358) . The combined group resumed walking and full weight-bearing activity significantly earlier than the simple group (P＜0.05) , additionally the former proved significantly superior to the latter in terms of VAS and Harris scores at 6 months after surgery and the latest follow-up (P＜ 0.05) . Radiographically, the combined group had significantly smaller area of femoral head lesion than the simple group at the latest follow up (P＜0.05) . Moreover, the combined group was significantly superior to the simple group in term of imaging grade of the femoral head at 6 months postoperatively and the latest follow- up (P＜0.05) . [Conclusion] The clinical outcomes of decompression and bone autografting combined with local application of zoledronic acid and PRP in the treatment of early femoral head necrosis is significantly better than that of decompression and bone autografting alone.