经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨治疗股骨头坏死的疗效及安全性分析OACSTPCD
Efficacy and Safety Analysis of Core Decompression Using Percutaneous Expandable Reamer Combined with PRO-DENSE Renewable Bone Graft-ing for the Treatment of Femoral Head Necrosis
目的 探究经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术在股骨头坏死(ONFH)治疗中的应用价值.方法 回顾性选取2020 年1 月1 日—2022 年1 月1 日100 例ONFH,根据手术方法分为2 组各50 例.对照组行髓芯减压自体骨植骨术,观察组行经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术.比较 2 组手术观察指标、手术疗效、并发症发生情况,以及手术前后神经源性炎症指标[神经生长因子(NGF)、前列腺素 E2(PGE2)]、血清生化指标[缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子 A(VEGF-A)、Ⅰ型前胶原氨基酸前肽(PⅠNP)、骨钙素(BGP)]、视觉模拟量表(VAS)评分、Harris髋关节功能评分.结果 观察组术中出血量(24.25±4.78)mL少于对照组(50.29±8.94)mL,住院时间(12.50±2.24)d短于对照组(15.12±3.37)d(P＜0.01).观察组术后1、3 及7d血清NGF、PGE2 低于对照组(P＜0.05).观察组术后1、3 及6 个月血清HIF-1α、VEGF-A、BGP及Har-ris髋关节功能评分较对照组高,血清PⅠNP及VAS评分较对照组低(P＜0.05).2 组手术优良率、并发症总发生率比较,差异无统计学意义(P＞0.05).结论 经皮扩张式铰刀髓芯减压联合PRO-DENSE可再生骨植骨术是ONFH患者安全可靠的治疗方式,能降低炎性因子水平,促进术后早期恢复,加速骨代谢,促进髋关节功能恢复,减轻患者疼痛.
Objective To explore the application value of core decompression using percutaneous expandable reamer combined with PRO-DENSE renewable bone grafting in the treatment of osteonecrosis of the femoral head(ONFH).Methods A total of 100 patients with ONFH treated from January 1,2020 to January 1,2022 were retrospectively selected and divid-ed into two groups with 50 cases in each group according to the surgical method.The control group underwent core decompres-sion and autogenous bone grafting,and the observation group underwent core decompression using percutaneous expandable reamer combined with PRO-DENSE regenerated bone grafting.Surgical observation indexes,surgical efficacy and complica-tions were compared between the two groups.Neurogenic inflammatory markers[nerve growth factor(NGF),prostaglandin E2(PGE2)],serum biochemical markers[hypoxia-inducible factor-1 α(HIF-1α),vascular endothelial growth factor A(VEGF-A),procollagen typeⅠN-propeptide(PⅠNP),osteocalcin(BGP)],visual analogue scale(VAS)score and Har-ris hip function score before and after operation were compared between the two groups.Results The intraoperative blood loss in the observation group[(24.25±4.78)mL]was less than that in the control group[(50.29±8.94)mL],and the length ofhospitalization[(12.50±2.24)d]was shorter than that in the control group[15.12±3.37)d](P＜0.01).Serum NGF and PGE2 in the observation group were lower than those in the control group at 1,3 and 7 d after operation(P＜0.05).Serum HIF-1α,VEGF-A,BGP and Harris hip function scores in observation group were higher than those in control group at 1,3 and 6 months after operation,while serum PⅠNP and VAS scores were lower than those in control group(P＜0.05).There was no significant difference in the excellent and good rate of operation and total incidence of complications between the two groups(P＞0.05).Conclusion Core decompression using percutaneous expandable reamer combined with PRO-DENSE regenerative bone grafting is a safe and reliable treatment for patients with ONFH,which can reduce the level of in-flammatory factors,promote early postoperative recovery,accelerate bone metabolism,promote hip function recovery,and al-leviate patients'pain.
郝志鹏;吴涛;李晓华;刘永强
050011 石家庄,石家庄市人民医院骨科
临床医学
股骨头坏死髓芯减压自体骨植骨扩张式铰刀PRO-DENSE可再生骨植骨神经生长因子疼痛血管内皮生长因子A
Femoral head necrosisCore decompressionAutogenous bone graftingExpandable reamerPRO-DENSE renewable bone graftingNerve growth factorPainVascular endothelial growth factor A
《临床误诊误治》 2024 (006)
36-41 / 6
河北省医学科学研究重点课题计划项目(20191465)
评论