Lu Yajie, Lu Xiao, Li Minghui, Chen Xiantao, Liu Youwen, Feng Xianfa, Yu Jinwei, Zhang Chengquan, Niu Dongsheng, Wang Siqun, Wang Zhen, Lu Jianxi
Department of Orthopedics, Xijing Hospital, The Air Force Military Medical University, No. 15 Changle West Road, Xi'an, Shaanxi, China.
School of Materials Science and Engineering, South China University of Technology, No.381 Wuhan Road, Guangzhou, Guangdong, China.
Int Orthop. 2018 Jul;42(7):1567-1573. doi: 10.1007/s00264-018-3919-6. Epub 2018 Apr 10.
To describe the rationale, the surgical technique, and the short-term follow-up results of a new minimally invasive treatment of osteonecrosis of the femoral head (ONFH) with an angioconductive bioceramic rod (ABR) implant.
Sixty-two patients (72 hips) with ARCO stage IIA-IIIC ONFH treated with the minimally invasive ABR from January 2012 to December 2016 were reviewed (17 females, 45 males, mean age 44.49). This technique used the angioconductive properties of the porous implant to repair the necrosis by driving vascularization from the trochanter to the necrotic area. Patients had a mean follow-up period of 26.74 months. The outcomes were evaluated by hip joint survival, radiograph, and the Harris Hip Score (HHS). The complications occurred during the treatment period were recorded.
No serious post-operative complications occurred during the treatment. The overall joint survival rate was 90.27%, with seven conversions to THA. Improvements were observed in 23 (31.95%) hips, 24 (33.33%) hips remained stable, and 25 (34.72%) hips had worse results according to the radiographic evaluation. The mean HHS at the end follow-up significantly improved compared to the pre-operative mean HHS (82.27 vs 58.14, p < 0.001). In both radiographic evaluation and HHS, the treatment was more effective on patients beneath 44 years old (p < 0.05); ARCO stage II compared to stage III (p < 0.05); and China-Japan Friendship Hospital (CJFH) type C compared to CJFH type L (p < 0.05).
The minimally invasive treatment of ONFH with ABR showed promising results in delaying or even terminating the progression of the necrosis and improving hip function, especially in younger patients and in the early stages of the disease.
描述采用血管传导性生物陶瓷棒（ABR）植入物对股骨头坏死（ONFH）进行新型微创治疗的原理、手术技术及短期随访结果。
回顾性分析2012年1月至2016年12月期间采用微创ABR治疗的62例（72髋）ARCO IIA-IIIC期ONFH患者（女性17例，男性45例，平均年龄44.49岁）。该技术利用多孔植入物的血管传导特性，通过驱动从转子到坏死区域的血管化来修复坏死。患者平均随访26.74个月。通过髋关节生存率、X线片及Harris髋关节评分（HHS）评估疗效。记录治疗期间发生的并发症。
治疗期间未发生严重术后并发症。总体关节生存率为90.27%，7例行全髋关节置换术（THA）转换。根据X线评估，23髋（31.95%）改善，24髋（33.33%）保持稳定，25髋（34.72%）结果较差。末次随访时的平均HHS较术前平均HHS显著改善（82.27对58.14，p<0.001）。在X线评估和HHS方面，该治疗对44岁以下患者更有效（p<0.05）；ARCO II期比III期更有效（p<0.05）；中日友好医院（CJFH）C型比L型更有效（p<0.05）。
采用ABR对ONFH进行微创治疗在延缓甚至终止坏死进展及改善髋关节功能方面显示出有前景的结果，尤其是在年轻患者和疾病早期阶段。
