四、本组患者临床随访及疗效评价

本组患者均行单侧或双侧髓心减压及异体骨笼结合脱钙骨基质和自体骨植入术,术后获得24～68个月随访,平均随访48个月。术前Harris评分平均为62.8 分, 术后为81.6 分, 提高18.7 分( P <0.001) 。术后Harris评分及提高分数的标准差非常大,这反映个体术后评分的偏差。所以,笔者分别计算手术成功和失败者Harris评分的改善情况:手术成功者术后Harris评分平均提高22.7分,而手术失败者分数减少14.0分。其X线影像学的变化与临床症状、体征的改变基本相符。术后24个月随访,手术成功率为91%。本组Harris评分差的5例髋,其中ⅡB 期2例、ⅢA期3例,除1例已行全髋关节置换术外,其余4例仍在继续行非手术治疗,并定期门诊随访。从随访的结果来看,髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术是治疗SteinbergⅠ、Ⅱ期股骨头坏死的有效方法。笔者认为此手术方法也适合于Steinberg ⅢA期股骨头坏死。

总之,髓心减压及异体螺纹骨笼结合脱钙骨基质和自体骨植入术治疗早期股骨头坏死的手术方法,尤其适合于年轻的股骨头坏死患者,对于推迟全髋关节置换术有重要意义。笔者认为该手术的应用前景很好,但因目前手术患者不多,还不能提供强有力的说服力,中远期临床效果有待于进一步临床观察研究。

(本文图1～4见光盘)

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来源：中华关节外科杂志(电子版) 作者：杨述华 吴星火 杨操 李进 许伟华