Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein
Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein
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DOI：
10.1097/01.blo.0000150312.53937.6f
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发表时间：
2004-12-01
影响因子：
4.2
通讯作者：
Urist, MR
中科院分区：
文献类型：
--
作者：
Lieberman, JR;Conduah, A;Urist, MR
对15例（17个髋关节）有症状的髋关节骨坏死患者进行了回顾性评价，这些患者采用髓芯减压联合同种异体、抗原提取、自溶腓骨同种异体移植物和50 mg部分纯化的人骨形态发生蛋白和非胶原蛋白治疗。患者的平均临床随访时间为53个月（范围，26-94个月）。髋关节骨坏死累及通过平片进行分类，采用改良的Ficat分期系统和MRI评估。15例髋关节被分类为Ficat IIA期，1例髋关节（1例患者）被分类为Ficat IIB期，1例髋关节（1例患者）被分类为Ficat III期。根据磁共振成像评估，14个髋关节累及50%或更少的股骨头，2/3或更少的股骨头承重面受累。14/15例IIA期疾病髋关节（93%; 13例患者）的手术获得临床成功。17例髋关节中有3例（3例患者）的股骨头影像学进展（Ficat IIA、IIB和III期），并转为全髋关节置换术。7例股骨头受累50%或更少且股骨头承重面在1/3和2/3之间的髋关节（6例患者）中，仅1例发生股骨头放射学进展。3个髋关节影像学无进展，累及不到1/3的股骨头承重面。需要在随机试验中进一步评价骨形态发生蛋白的潜在疗效。
A retrospective evaluation was done of 15 patients (17 hips) with symptomatic osteonecrosis of the hip treated with core decompression combined with an allogeneic, antigen-extracted, autolyzed fibula allograft and 50 mg of partially purified human bone morphogenetic protein and noncollagenous proteins. The average duration of clinical followup of the patients was 53 months (range, 26-94 months). The osteonecrotic involvement of the hip was classified by plain radiographs using a modification of the Ficat staging system and MRI evaluations. Fifteen hips were classified as Ficat Stage IIA, one hip (one patient) was classified as Ficat Stage IIB, and one hip (one patient) was classified as Ficat Stage III. Fourteen hips had involvement of 50% or less of the femoral head and 2/3 or less involvement of the weight-bearing surface of the femoral head, based on a magnetic resonance imaging evaluation. The procedures were a clinical success in 14 of 15 hips (93%; 13 patients) with Stage IIA disease. Three of 17 hips (three patients) had radiographic progression (Ficat Stages IIA, IIB, and III) of the femoral head and were converted to total hip replacements. Only one of seven hips (six patients) with 50% or less involvement of the femoral head and between 1/3 and 2/3 of the weight-bearing surface of the femoral head developed radiographic progression of the femoral head. There was no radiographic progression in the 3 hips with less than 1/3 involvement of the weight-bearing surface of the femoral head. Further evaluation of the potential efficacy of bone morphogenetic protein is required in randomized trials.