Lieberman Jay R, Conduah Augustine, Urist Marshall R
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, CHS 76-134, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
Clin Orthop Relat Res. 2004 Dec(429):139-45. doi: 10.1097/01.blo.0000150312.53937.6f.
A retrospective evaluation was done of 15 patients (17 hips) with symptomatic osteonecrosis of the hip treated with core decompression combined with an allogeneic, antigen-extracted, autolyzed fibula allograft and 50 mg of partially purified human bone morphogenetic protein and noncollagenous proteins. The average duration of clinical followup of the patients was 53 months (range, 26-94 months). The osteonecrotic involvement of the hip was classified by plain radiographs using a modification of the Ficat staging system and MRI evaluations. Fifteen hips were classified as Ficat Stage IIA, one hip (one patient) was classified as Ficat Stage IIB, and one hip (one patient) was classified as Ficat Stage III. Fourteen hips had involvement of 50% or less of the femoral head and 2/3 or less involvement of the weight-bearing surface of the femoral head, based on a magnetic resonance imaging evaluation. The procedures were a clinical success in 14 of 15 hips (93%; 13 patients) with Stage IIA disease. Three of 17 hips (three patients) had radiographic progression (Ficat Stages IIA, IIB, and III) of the femoral head and were converted to total hip replacements. Only one of seven hips (six patients) with 50% or less involvement of the femoral head and between 1/3 and 2/3 of the weightbearing surface of the femoral head developed radiographic progression of the femoral head. There was no radiographic progression in the 3 hips with less than 1/3 involvement of the weightbearing surface of the femoral head. Further evaluation of the potential efficacy of bone morphogenetic protein is required in randomized trials.
对15例（17髋）有症状的髋关节骨坏死患者进行了回顾性评估，这些患者接受了髓芯减压联合异体、抗原提取、自溶腓骨移植以及50毫克部分纯化的人骨形态发生蛋白和非胶原蛋白治疗。患者的临床随访平均时长为53个月（范围26 - 94个月）。采用改良的菲卡特分期系统通过X线平片和MRI评估对髋关节骨坏死累及情况进行分类。15髋被分类为菲卡特IIA期，1髋（1例患者）被分类为菲卡特IIB期，1髋（1例患者）被分类为菲卡特III期。基于磁共振成像评估，14髋股骨头受累面积为50%或更小，股骨头负重面受累面积为2/3或更小。对于IIA期疾病，15髋中有14髋（93%；13例患者）手术临床成功。17髋中有3髋（3例患者）出现股骨头影像学进展（菲卡特IIA期、IIB期和III期）并转为全髋关节置换。在股骨头受累面积为50%或更小且股骨头负重面受累面积在1/3至2/3之间的7髋（6例患者）中，只有1髋出现股骨头影像学进展。在股骨头负重面受累面积小于1/3的3髋中未出现影像学进展。需要在随机试验中进一步评估骨形态发生蛋白的潜在疗效。
