Sun Wei, Li Zirong, Shi Zhencai, Wang Bailiang, Shi Shaohui, Liu Bingli, Guo Wanshou
Center for Osteonecrosis and Joint Preserving and Reconstruction, Department of Orthopaedics, China-Japan Friendship Hospital, Beijing 100029, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Oct;22(10):1153-6.
To retrospectively analyze the clinical effect of light bulb operation with nano-hydroxyapatite/ collagen in a consecutive series of patients with osteonecrosis of the femoral head (ONFH).
From January 2001 to July 2005, 26 patients (35 hips) were treated, 16 males and 10 females, aged 19-54 years old (33.5 on average). The course of disease was 12-36 months (18 months on average). Based on the etiology, 15 cases (22 hips) were steroid induced type, 10 (12 hips) were alcohol induced type and the other one (1 hip) was idiopathic type. According to the system of Association Research Circulation Osseous (ARCO), there were 6 hips of stage IIB, 16 hips of stage IIC, 9 hips of stage IIIA, 3 hips of stage IIIB and 1 hip of stage IIIC. The Harris score was 62.2 +/- 7.5. All the patients who had undergone light bulb operation with nano-hydroxyapatite/collagen were evaluated both clinically and radiographically. The bone graft mixture rate of nano-hydroxyapatite/collagen and autogenous bone was 1 : 1, and the mixed bone graft was 6 times of the scraped osteonecrosis volume (30-48 mL).
The incisions of all 26 patients (35 hips) obtained healing by first intention. The 2 cases, which got lateral femoral cutaneous nerve injury during the operation, recovered 3-6 months after the operation without any treatment. Another 2 cases got heterotopic ossification 3 months after operation, with no special treatment. All the 26 patients (35 hips) were followed up for 2-7 years (3.5 on average). The patients' bone healing began from the 3rd month after operation. The postoperative Harris score was 85.1 +/- 16.2, and there was significant difference compared with the preoperative one (P < 0.001). There were 15 hips of excellent, 11 of good, 5 of fair, and 4 of poor which received total hip arthroplasty at the end of the follow-up. According to imaging, 5 hips were progressed from preoperative IIC to IIIA, while the other hips were radiologically stable, with no progress of ONFH.
Light bulb operation with nano-hydroxyapatite/collagen provides a surgical treatment to treat early ONFH with satisfactory clinical outcomes. Nano-hydroxyapatite/collagen is beneficial for the repair and reconstruction of ONFH and suitable for femoral-head-preserving operation for the patients with ONFH of stage II.
回顾性分析采用纳米羟基磷灰石/胶原进行灯泡状手术治疗一系列连续性股骨头坏死（ONFH）患者的临床效果。
2001年1月至2005年7月，共治疗26例患者（35髋），男性16例，女性10例，年龄19 - 54岁（平均33.5岁）。病程12 - 36个月（平均18个月）。根据病因，15例（22髋）为激素诱导型，10例（12髋）为酒精诱导型，另1例（1髋）为特发性类型。根据骨循环研究协会（ARCO）分期系统，IIB期6髋，IIC期16髋，IIIA期9髋，IIIB期3髋，IIIC期1髋。Harris评分62.2±7.5。对所有接受纳米羟基磷灰石/胶原灯泡状手术的患者进行临床和影像学评估。纳米羟基磷灰石/胶原与自体骨的骨移植混合比例为1∶1，混合骨移植量为刮除的坏死骨体积的6倍（30 - 48 mL）。
26例患者（35髋）切口均一期愈合。2例患者术中出现股外侧皮神经损伤，术后3 - 6个月未经任何治疗自行恢复。另2例患者术后3个月出现异位骨化，未进行特殊治疗。26例患者（35髋）均随访2 - 7年（平均3.5年）。患者术后3个月开始骨愈合。术后Harris评分为85.1±16.
