Objective To evaluate the clinical outcome associated with the core decompression in combination with the nano-hydroxyapatite/collagen composite rod combined with decalcified bone matrix in a consecutive series of patients with osteonecrosis of femoral head,especially the prevention of collapse of femoral head and its predisposing factors.Methods From August,2012 to May,2013,46 pationts (50 hips) who had undergone core decompression in combination with nano-hydroxyapatite/collagen composite rod insertion in corporated with decalcified bone matrix in our hospital were involved in this study.Postoperative care consisted of prophylactic intravenous antibiotic and anticoagulation therapy.Patients were instructed to be non-weight-bearing for 3 weeks,to partial weight-bear for the next 3 weeks,and to weight bear as tolerated thereafter.All patients were evaluated both clinically and radiographically.The primary clinical outcome of this study was functional improvement assessed with the Harris hip score.Serial radiograms of the pelvis were taken at 1,3,6,12 months post-operatively to analyze the process of osteonecrosis.Results All patients followed up for 12 months,no one suffer complications.The mean Harris score pre-operation was 65.6 ± 10.6,post-operation score was 87.5 ± 15.3,with a mean improvement of 21.8 ± 13.2 (P ＜ 0.05).According to Harris hip score system,excellent for 30 hips,good for 14 hips,fair for 2 hip and poor for 4 hips.Refer to the Kaplan-Meier survivorship curve,the success rate at 12 months post-operatively was 92％.Radiological changes coincided with clinical changes.Conclusion Core decompressionin combination with nano-hydroxyapatite/ collagen composite rod insertion in corporated with decalcified bone matrix provided a minimally invasive surgical treatment option to treat early stage osteonecrotic hips(stage Ⅰ and Ⅱ) and to prevent femoral heads from collapsing,with clinical outcomes and success rates priorto other commonly used surgical procedures.%目的 回顾性分析髓芯减压联合纳米晶胶原基人工骨支撑棒结合脱钙骨基质治疗早期股骨头坏死临床疗效及其影响因素. 方法 2012年8月至2013年5月,华中科技大学附属协和医院骨科收治早期股骨头坏死的患者46例(50髋),年龄23 ～ 51岁,平均34.2岁;所有患者经大腿外侧小切口入路,行髓芯减压联合纳米晶胶原基人工骨支撑棒结合脱钙骨基质植入术.术后预防性地静脉给予抗生素及抗凝治疗;术后3周内禁止负重,3周后可部分负重,逐渐增加至完全负重.所有患者均获随访,进行临床及影像学评估.临床评估采用Harris评分系统,评价术后患髋功能改善情况;影像学评估主要是于术后1、3、6、12、18个月摄取骨盆X线片,观察股骨头修复及有无坏死情况. 结果 术后12个月进行疗效评估,术前Harris评分平均为(65.6±10.6)分,术后提高至(87.5±15.3)分,提高分数平均为(21.8±13.2)分(P＜0.05).参考Harris评分系统,本组50髋病例中,优30髋,良14髋,可2髋,差4髋,优良率达88％.Kaplan-Meier生存曲线分析表明,术后12个月成功率为92％,X线片的结果显示有4髋表现出影像学进展,影像学变化与临床症状、体征改变相符合. 结论 髓芯减压联合纳米晶胶原基人工骨支撑棒结合脱钙骨基质植入术治疗早期股骨头坏死,治疗效果优良,适合于Ⅰ期和Ⅱ期的股骨头坏死患者.
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