富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究

doi:10.13418/j.issn.1001-165x.2018.01.021

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (1): 93-97.doi: 10.13418/j.issn.1001-165x.2018.01.021

富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究

姜良斌^1，2，　刘松^1，2，　岳永彬^1，2，　孙海忠^1，2，　韦标方¹

1. 临沂市人民医院骨科，山东临沂 276001；　2. 广州中医药大学，广州 510006

收稿日期:2017-07-29 出版日期:2018-01-25 发布日期:2018-03-06
作者简介:姜良斌, 博士，研究方向：中西医结合治疗股骨头坏死，E-mail:jianglb1984 @163.com
基金资助:
2014山东省科技发展计划（2014GSF119022）

Early research of the platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for the treatment of the osteonecrosis of the femoral head

JIANG Liang-bin^1,2， LIU Song^1,2, YUE Yong-bin^1,2, SUN Hai-zhong ^1,2，WEI Biao-fang ¹

1.Department of Orthopedics, Linyi People's Hospital, Linyi 276001, Shandong Province, China; 2.Guangzhou University of Chinese Medicine, Guangzhou 510006, China

Received:2017-07-29 Online:2018-01-25 Published:2018-03-06

摘要/Abstract

摘要：

目的　探讨富血小板血浆（PRP）促进早期股骨头坏死修复的作用效果。方法　2014年7月至2017年5月，将采用改良二次离心法制作的 PRP 用于治疗早期股骨头坏死26 例(35髋)（ PRP 组）。采用非PRP治疗的治疗早期股骨头坏死24例(32髋)患者（对照组），两组进行疗效比较，术后1、3、6个月行X线片复查，观察病情变化，用髋关节Harris评分、疼痛VAS评分进行疗效评价,观察比较两组股骨头修复情况以及坏死进展并加以分析。结果　两组患者均获随访，随访时间6个月。1.术后6个月影像学检查显示，PRP组患者股骨头外形良好，均未发生变形及塌陷，同种异体腓骨整合良好，股骨头密度增加。对照组7例发生塌陷，同种异体腓骨与股骨头界限明显，整合差。末次随访时效果明显优于对照组。2. PRP组Harris髋关节评分由术前（67.82±9.61）分提高至末次随访的（88.45±6.02）分，对照组Harris髋关节评分由术前（69.74±8.26）分提高至末次随访的（78.36±6.17）分；PRP组疼痛VAS评分由术前（4.6±1.2）分下降至末次随访的（1.7±1.0）分，对照组疼痛VAS评分由术前（4.3±0.9）分下降至末次随访的（2.3±1.1）分。两组治疗前后比较差异均有统计学意义（P<0.05）。结论　临床使用富血小板血浆后可以改善患者髋部疼痛、关节功能，促进骨长入，具有显著的临床应用价值。

关键词: 富血小板血浆, 　股骨头坏死, 　同种异体腓骨, 　钻孔减压

Abstract:

Objective　To investigate the potency of the platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for the treatment of the osteonecrosis of the femoral head.　Methods　From July 2014 to May 2017, 26 cases (35 hips) of osteonecrosis of the femoral head were treated with platelet-rich plasma combined with core decompression and allogeneic fibula rod support (PRP group) and 24 cases (32 hips) with core decompression and allogeneic fibula rod support only (control group). At 1, 3，6 months after operation, Patients were followed up and evaluated using Harris hip score、VAS score and radiography.　Results　All the patients(67 hips) were followed up thoroughly and the follow-up periods were 6 months. At 6 months after operation, the shape of the femoral heads of the PRP groups was good with no deformation and collapse. The location of the top of the allograft fibula rod was perfect with no fibula rod out. The fibula rods made integration with the surrounding bone without infection. Harris score of PRP group before and after treatment increased from 67.82±9.61 to 88.45±6.02, Harris score of control group before and after treatment increased from 69.74±8.26 to 78.36±6.17；VAS score of PRP group before and after treatment increased from 4.6±1.2 to 1.7±1.0, VAS score of control group before and after treatment increased from 4.3±0.9 to 2.3±1.1. There were statistically significant differences in the pre-therapy and post-treatment groups (P<0.05) and there were statistically significant differences in the postoperation between the two groups (P<0.05).　Conclusions　Use of the platelet-rich plasma (PRP) in clinic can ease hip pain and improve joint function, and it is highly valuable in clinical use．

Key words: Platelet-rich plasma, 　Osteonecrosis of the femoral head, 　 Allogeneic fibula rod, 　Core decompression

姜良斌,刘松,岳永彬,孙海忠,韦标方 . 富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究[J]. 中国临床解剖学杂志, 2018, 36(1): 93-97.

JIANG Liang-bin,LIU Song, YUE Yong-bin, SUN Hai-zhong，WEI Biao-fang. Early research of the platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for the treatment of the osteonecrosis of the femoral head[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(1): 93-97.

参考文献

[1] Okazaki S, Nagoya S, Tateda K, et al. Experimental rat model for alcohol-induced osteonecrosis of the femoral head[J]. Int J Exp Pathol, 2013, 94(5):312-319.
[2] Wu Z, Ji C, Li H, et al. Elevated level of membrane microparticles in the disease of steroid-induced vascular osteonecrosis[J]. J Craniofac Surg, 2013, 24(4):1252-1256.
[3] Fukushima W, Fujioka M, Kubo T, et al. Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head[J]. Clin Orthop Relat Res, 2010, 468(10):2715-2724.
[4] Chen CC， Lin CL， Chen WC， et al． Vascularized iliac bone-grafting for osteonecrosis with segmental collapse of the femoral head[J]． J Bone Joint Surg Am， 2009，91(10): 2390-2394．
[5] Steinberg ME， Hayken GD， Steinberg DR． The“conservative”management of avascular necrosis of the femoral head[M]∥Arlet J， Ficat PR， Hungerford DS， editors．Bone circulation． Baltimore: Williams and Wilkins， 1984: 334-337．
[6] Garrigues GE， Aldridge JM 3rd， Friend JK， et al． Free vascularized fibular grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation[J]． Microsurgery， 2009， 29(5): 342-345.
[7] Hungerford DS． Treatment of osteonecrosis of the femoral head: everything's new[J]． J Arthroplasty， 2007， 22(4): 91-94．
[8] Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing[J]. Plast Reconstr Surg,2004,114(6):1502-1508.
[9] van den Dolder J, Mooren R, Vloon AP, et al. Platelet-rich plasma: quantification of growth factor levels and the effect on growth and differentiation of rat bone marrow cells[J]. Tissue Eng, 2006, 12(11):3067-3073.
[10]Kon E, Filardo G, Delcogliano M, et al. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee[J]. Injury, 2009, 40(6): 598-603.
[11]Wu W, Chen F, Liu Y,et al. Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model[J]. J Oral Maxillofac Surg, 2007, 65(10):1951-1957.
[12Feitosa ML, FadelL, Beltrão-Braga PC, et al.Successful transplant of mesenchymal stem cells in induced osteonecrosis of the ovine femoral head:preliminary results[J]. Acta Cir Bras, 2010, 25(5): 416-422.
[13Marx RE, Carlson ER, Eichstaidt RM, et al. Platelet-rich plasma: Growth factor enhancement for bone grafts[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(6): 638-646.
[14] Okuda K, Kawase T, Momose M, et al. Platelet-rich plasma contains high Levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodongtally related cells in vitro[J]. J Periodontol, 2003, 74(6): 849-857.
[15]Landesberg R, Roy M, Glicsman RS. Quantification of growth factor levels using a simplified method of platelet-rich plasma gel preparation[J]. J Oral Maxillofac Surg, 2003, 58(3): 297-300.
[16] Roldán JC, Jepsen S, Miller J, et al. Bone formation in the presence of platelet-rich plasma vs. bone morphogenetic protein-7[J]. Bone, 2004, 34(1): 80-90.
[17] Weibrich G, Hansen T, Kleis W, et al. Effect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration[J]. Bone, 2004, 34(4): 665-671.
[18]Danesh-Meyer MJ, Filstein MR, Shanaman R. Histological evaluation of sinus augmentation using platelet rich plasma(PRP): a case series[J]. J Int Acad Periodontol, 2001, 3(2): 48-56.
[19]Welbrich G, Kleis WK, Hafner G, et al. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count[J]. J Craniomaxillofac Surg, 2002, 30(2): 97-102.
[20] Sánchez AR, Sheridan PJ, Kupp LI. Is platelet-rich plasma the perfect enhancement factor? A current review[J]. Int J Oral Maxillofac Implants, 2003, 18(1): 93-103.
[21] Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery[J]. Facial Plast Surg, 2002, 18(1): 27-33.
[22]Yazawa M, Ogata H, Kimura A,et al. Basic studies on the bone formation ability by platelet rich plasma in rabbits[J]. J Craniofac Surg, 2004, 15(3): 439-446.
[23] Risau W, Drexler H, Mironov V, et al. Platelet-derived growth factor is angiogenic in vivo[J]. Growth Factors, 1992, 7(4): 261-266.
[24] Kitoh H, Kitakoji T, Tsuchiya H, et al. Transplantation of marrow-derived mesenchymal stem cells and platelet-rich plasma during distraction osteogenesis-a preliminary result of three cases[J]. Bone, 2004, 35(4): 892-898.
[25]Lynch SE, Colvin RB, Antoniades HN. Growth factors in wound healing.Single and synergistic effects on partial thickness porcine skin wounds[J]. J Clin Invest, 1989, 84(2): 640-646.
[26]Okuda K, Kawase T, Momose M, et al. Platelet-rich plasma contains high Levels of platelet-derived growth factor and transforming growth factor-beta and modulates the proliferation of periodongtally related cells in vitro[J]. J Periodontol, 2003, 74(6): 849-857.[27] Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with application in oral and maxillofacial surgery[J]. J Oral Maxillofac Surg, 1997, 55(11): 1294-1299.
[28]Aghaloo TL, Moy PK, Freymiller EG. Investigation of platelet-rich plasma in rabbit cranial defects: a pilot study[J]. J Oral Maxillofac Surg, 2002, 60(10): 1176-1181.
[29]Choi BH, Im CJ, Huh JY, et al. Effect of platelet-rich plasma on bone regeneration in autogenous bone graft[J]. Int J Oral Maxillofac Surg, 2004, 33(1): 56-59.
[30]Kim SG, Kim WK, Park JC, et al. A comparative study of osseointegration of Avana implants in a demineralized freeze-dried bone alone or with platelet-rich plasma[J]. J Oral Maxillofac Surg, 2002, 60(9): 1018-1025.

富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究

Early research of the platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for the treatment of the osteonecrosis of the femoral head

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

Metrics

本文评价

推荐阅读 0

[1]	蔡昊, 陈春. 长链非编码LncRNA-MEG3在激素性股骨头坏死中的表达及相关性研究[J]. 中国临床解剖学杂志, 2022, 40(2): 187-191.
[2]	姜良斌,肖伯莲,刘松,韦标方. 富血小板血浆联合高位股骨头颈开窗植骨支撑术治疗早期股骨头坏死的研究[J]. 中国临床解剖学杂志, 2018, 36(4): 449-452.
[3]	张健，　殷富裕，　彭吾训. 带股方肌蒂骨瓣移位治疗成人股骨头缺血性坏死的疗效及安全性分析[J]. 中国临床解剖学杂志, 2017, 35(2): 228-231.