摘要
背景:自体富血小板血浆是自体全血经离心后得到的血小板浓缩物,研究证实自体富血小板血浆具有可促进骨与软骨修复、组织修复及血管再生等功能,在口腔、骨科、运动医学、整形美容及皮肤科等各学科广泛运用。目的:观察和探讨吻合血管游离腓骨移植联合自体富血小板血浆治疗青壮年早期股骨头缺血性坏死的临床效果。方法:选取2014年5月至2018年8月期间,收住院治疗青壮年早期股骨头缺血性坏死患者20例(24髋);全部患者行股骨头坏死病灶刮除、吻合血管游离腓骨移植联合富血小板血浆治疗;术后12个月采用Harris评分系统评价,计算患髋优良率、改善率,记录患者术前及术后疗效评价、影像学变化、随访结果及并发症情况。结果与结论:①20例(24髋)患者均获得如期随访,术后随访时间1.0-2.5年,平均1.35年,采用Harris评分评估疗效,优12髋,良10髋,可1髋,差1髋,优良率达91.7%;②术前及术后12个月的Harris评分比较有显著性意义(P=0.000);③术后12个月随访中有3髋仍有疼痛,2髋有影像学上的进展,改善等级:17髋,不变等级:5髋,失败等级:2髋,改善率为91.7%,患者的临床症状、体征与影像学表现进展变化相符合;④3例(4髋)患者术后出行同侧大腿前外侧麻木,3个月后完全恢复正常,其中1例(1髋)患者术后18个月股骨头缺血性坏死(ARCO分期IV期)后行髋关节置换,均无切口不愈合、感染和静脉血栓形成等并发症;⑤上述数据显示,吻合血管游离腓骨移植联合自体富血小板血浆治疗早期股骨头缺血性坏死短期临床效果较好。
BACKGROUND:Autologous platelet-rich plasma is a platelet concentrate obtained by centrifugation of autologous whole blood.Studies have proved that autologous platelet-rich plasma can promote bone and cartilage repair,tissue repair,and vascular regeneration,and it is widely used in various disciplines such as stomatology,orthopedics,sports medicine,plastic cosmetology and dermatology.OBJECTIVE:To observe and discuss the clinical effect of free fibular transplantation combined with autologous platelet-rich plasma in the treatment of avascular necrosis of the femoral head in young adults.METHODS:From May 2014 to August 2018,20 patients(24 hips)with early avascular necrosis of the femoral head in young adults were subjected to curettage of femoral head necrosis focus and free fibular transplantation with vascular anastomosis and platelet-rich plasma.Harris score system was used for evaluation at 12 months after operation to calculate the excellent and good rate and improvement rate of affected hips.Curative effect evaluation,imaging changes,follow-up results and complications of patients were recorded before and after operation.RESULTS AND CONCLUSION:All 20 patients(24 hips)were followed up as scheduled.The follow-up time after operation was 1.0-2.5 years,with an average of 1.35 years.Harris score was used to evaluate curative effects,with excellent in 12 hips,good in 10 hips,fair in 1 hip,poor in 1 hip,and an excellent and good rate of 91.7%.There was a significant difference in the Harris score of the affected hip before operation and 12 months after operation(P=0.000).During the 12-month follow-up after the operation,3 hips still had pain,2 hips had imaging progress.Improvement grade was in 17 hips,unchanged grade in 5 hips,failure grade in 2 hips,with the improvement rate of 91.7%,and the clinical symptoms and signs of the patients were consistent with the imaging performance progress.Three patients(four hips)experienced numbness in the anterolateral thigh of the same side after operation,and completely recovered to normal after 3 months.One patient(one hip)underwent hip replacement 18 months after operation for avascular necrosis of femoral head(ARCO stage IV).No complications such as incision nonunion,infection and venous thrombosis were found.These results indicate that the anastomosed fibular graft combined with autologous platelet-rich plasma has good short-term clinical effect and high excellent rate in the treatment of early avascular necrosis of the femoral head.
作者
莫凡
花奇凯
赵劲民
沙轲
谢琦
张近
杨渊
黄巍峰
王豪
黄浩
陈英华
Mo Fan;Hua Qikai;Zhao Jinmin;Sha Ke;Xie Qi;Zhang Jin;Yang Yuan;Huang Weifeng;Wang Hao;Huang Hao;Chen Yinghua(Department of Orthopaedics,Langdong Hospital of Guangxi Medical University,Nanning 530000,Guangxi Zhuang Autonomous Region,China;Department of Orthopaedics,the First Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Zhuang Autonomous Region,China;Graduate School of Guangxi University of Chinese Medicine,Nanning 530200,Guangxi Zhuang Autonomous Region,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第35期5675-5681,共7页
Chinese Journal of Tissue Engineering Research
基金
广西科学研究与技术开发项目(桂科攻1598011-5),项目负责人:沙轲
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190753),项目负责人:莫凡。
关键词
骨
股骨头
坏死
腓骨
骨移植
血管
血浆
植骨
bone
femoral head
necrosis
fibula
bone transplantation
vessel
plasma
bone graft
