标题：血管介入联合髓芯减压植骨术治疗早中期股骨头缺血性坏死的疗效观察

      作者：刘锋 1，石运潮 2，周科 1，刘冬 3，寇艳艳 1，陈明凤 1，温建生 1    1.北京中医药大学孙思邈医院周围血管病科，陕西 铜川 727106；2.北京中医药大学孙思邈医院骨一科，陕西 铜川 727106；3.中国人民解放军空军军医大学第一附属医院骨科，陕西 西安 710000

      卷次： 2023年34卷23期

      【摘要】 目的 探究血管介入联合髓芯减压植骨术治疗早中期股骨头缺血性坏死(ANFH)患者的临床疗效。方法 前瞻性选取 2015年 6月至 2022年 6月在北京中医药大学孙思邈医院周围血管病科就诊的 113例早中期ANFH患者作为研究对象，采用随机数表法分为观察组56例和对照组57例，比较两组患者术后6个月的治疗效果及并发症、两组术前及术后6个月的Harris评分(疼痛、功能、畸形、关节活动)、骨代谢标志物[骨钙素(OC)、骨形态发生蛋白-2 (BMP-2)、胰岛素样生长因子-1 (IGF-1)]和血液流变学指标[全血高切黏度(WBHS)、全血低切黏度(WBLS)、血浆黏度(PV)]。结果 术后6个月，观察组患者的优良率为94.64%，明显高于对照组的78.95%，差异有统计学意义(P<0.05)；术后6个月，观察组患者的Harris量表疼痛、功能、畸形、关节活动各项评分分别为(37.82±5.82)分、(41.67±5.96)分、(3.27±0.52)分、(3.85±0.59)分，明显高于对照组的(34.68±5.19)分、(37.09±5.39)分、(2.82±0.46)分、(3.35±0.52)分，差异均有统计学意义(P<0.05)；术后 6个月，观察组患者的OC、BMP-2及 IGF-1水平分别为(6.85±0.89) μg/L、(17.74±2.31) μg/L、(88.35±10.93) ng/mL，明显高于对照组的(5.54±0.78) μg/L、(13.47±1.79) μg/L、(81.36±10.96) ng/mL，差异均有统计学意义(P<0.05)；术后6个月，观察组患者的WBHS、WBLS及PV分别为(5.32±0.74) mPa·s、(6.82±0.87) mPa·s、(1.74±0.21) mPa·s，明显低于对照组的(6.27±0.81) mPa·s、(8.14±1.23) mPa·s、(2.15±0.29) mPa·s，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的不良反应总发生率为3.57%，略低于对照组的7.02%，但差异无统计学意义(P>0.05)。结论 血管介入联合髓芯减压植骨术有助于改善ANFH患者的髋关节功能、骨代谢及血液流变学指标，提高生活质量，且安全性较高。
      【关键词】 股骨头缺血性坏死；超选择血管介入；髓芯减压植骨术；髋关节功能；骨代谢指标
      【中图分类号】 R681 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3406—05

Curative effect of vascular intervention combined with core decompression bone graft in the treatment of early andmiddle avascular necrosis of the femoral head.
LIU Feng 1, SHI Yun-chao 2, ZHOU Ke 1, LIU Dong 3, KOU Yan-yan 1,CHEN Ming-feng 1, WEN Jian-sheng 1. 1. Department of Peripheral Vascular Diseases, Sun Simiao Hospital, BeijingUniversity of Traditional Chinese Medicine, Tongchuan 727106, Shaanxi, CHINA; 2. The First Department of Orthopaedics,Sun Simiao Hospital, Beijing University of Traditional Chinese Medicine, Tongchuan 727106, Shaanxi, CHINA; 3. Departmentof Orthopaedics, First Affiliated Hospital of Air Force Medical University of PLA, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To explore the clinical curative effect of vascular intervention combined with core decom-pression bone graft in patients with early and middle avascular necrosis of the femoral head (ANFH).Methods A total of113 patients with early and middle ANFH treated in Department of Peripheral Vascular Diseases, Sun Simiao Hospital,Beijing University of Traditional Chinese Medicine between June 2015 and June 2022 were prospectively enrolled as theresearch objects. According to random number table method, they were divided into an observation group (n=56) and acontrol group (n=57). The curative effect and complications at 6 months after surgery, Harris scores (pain, function, defor-mity, joint activity), bone metabolism markers [osteocalcin (OC), bone morphogenetic protein-2 (BMP-2), insulin-likegrowth factor-1 (IGF-1)], and hemorheology indexes [whole blood high shear viscosity (WBHS), whole blood low shearviscosity (WBLS), plasma viscosity (PV)] before and at 6 months after surgery were compared between the two groups.Results At 6 months after surgery, the excellent and good rate of the observation group was significantly higher thanthat of control group (94.64% vs 78.95%, P<0.05). At 6 months after surgery, scores of Harris (pain, function, deformity,joint activity) in the observation group were (37.82±5.82) points, (41.67±5.96) points, (3.27±0.52) points, and (3.85±0.59) points, significantly higher than (34.68±5.19) points, (37.09±5.39) points, (2.82±0.46) points, (3.35±0.52) points inthe control group (P<0.05). At 6 months after surgery, levels of OC, BMP-2, and IGF-1 in the observation group were(6.85±0.89) μg/L, (17.74±2.31) μg/L, and (88.35±10.93) ng/mL, significantly higher than (5.54±0.78) μg/L, (13.47±1.79) μg/L, (81.36±10.96) ng/mL in the control group (P<0.05). At 6 months after surgery, WBHS, WBLS, and PV inthe observation group were (5.32±0.74) mPa·s, (6.82±0.87) mPa·s, and (1.74±0.21) mPa·s, significantly lower than(6.27±0.81) mPa·s, (8.14±1.23) mPa·s, (2.15±0.29). mPa·s in the control group (P<0.05). During treatment, the inci-dence of adverse reactions in the observation group was slightly lower than that in the control group (3.57% vs 7.02%, P>0.05). Conclusion Vascular intervention combined with core decompression bone graft is beneficial to improve hipfunction, bone metabolism indexes, hemorheology indexes, and quality of life in ANFH patients, with high safety.
      【Key words】 Avascular necrosis of the femoral head; Superselective vascular intervention; Core decompressionbone graft; Hip function; Bone metabolism index