生物陶瓷棒联合骨形态发生蛋白治疗股骨头坏死

doi:10.3877/cma.j.issn.1674-134X.2026.02.014

中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 242 -247. doi: 10.3877/cma.j.issn.1674-134X.2026.02.014

临床经验

生物陶瓷棒联合骨形态发生蛋白治疗股骨头坏死

宋晓阳¹, 韩宏²^,^†(

), 周胜虎¹, 乔永杰¹, 张浩强¹, 沙丽蓉³, 娄金鹏⁴, 刘鹏¹, 刘振豪¹, 宋奇峰¹

¹　730050　兰州，解放军联勤保障部队第九四〇医院骨科中心
²　710000　西安市长安医院骨科
³　730050　兰州，解放军联勤保障部队第九四〇医院皮肤科
⁴　730050　兰州大学第一医院骨科

收稿日期:2024-10-12 出版日期:2026-04-01
通信作者: 韩宏
基金资助:
陕西省重点研发计划(2021SF-338); 甘肃省重点研发计划(25YFFA065); 联勤保障部队第九四〇医院高层次人才培养工程(2024-G3-5)

Treatment of osteonecrosis of femoral head with bioceramic rod combined with bone morphogenetic protein

Xiaoyang Song¹, Hong Han²^,^†(), Shenghu Zhou¹, Yongjie Qiao¹, Haoqiang Zhang¹, Lirong Sha³, Jinpeng Lou⁴, Peng Liu¹, Zhenhao Liu¹, Qifeng Song¹

¹ Orthopaedic Center, the 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Lanzhou 730050, China
² Department of Orthopaedics, Xi’an Chang’an Hospital, Xi’an 710000, China
³ Department of Dermatology, the 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Lanzhou 730050, China
⁴ Department of Orthopaedics, the First Hospital of Lanzhou University, Lanzhou 730050, China

Received:2024-10-12 Published:2026-04-01
Corresponding author: Hong Han

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引用本文：

宋晓阳, 韩宏, 周胜虎, 乔永杰, 张浩强, 沙丽蓉, 娄金鹏, 刘鹏, 刘振豪, 宋奇峰. 生物陶瓷棒联合骨形态发生蛋白治疗股骨头坏死[J/OL]. 中华关节外科杂志(电子版), 2026, 20(02): 242-247.

Xiaoyang Song, Hong Han, Shenghu Zhou, Yongjie Qiao, Haoqiang Zhang, Lirong Sha, Jinpeng Lou, Peng Liu, Zhenhao Liu, Qifeng Song. Treatment of osteonecrosis of femoral head with bioceramic rod combined with bone morphogenetic protein[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 242-247.

目的

分析生物陶瓷棒联合重组人骨形态发生蛋白（rh-BMP）治疗中青年人群国际骨循环研究协会(ARCO)分期Ⅱ、Ⅲ期股骨头坏死（ONFH）疗效评价。

方法

收集自2018年1月至2021年6月联勤保障部队第九四〇医院关节外科收治的26例股骨头坏死患者，并行生物陶瓷棒及BMP植入术，记录术前术后影像学结果、疼痛数字评价量表（NRS）、术前及末次随访Harris评分。手术前后比较采用配对样本t检验。所有检验均以P<0.05为差异有统计学意义。

结果

随访时间10~26个月，平均（18.0±1.6）个月，末次随访时保髋率为92.8%（26/28），NRS评分由（4.07±0.26）降低为（1.50±0.92）（t=14.181，P<0.001），髋关节Harris评分由（60.00±6.24）提高为（85.54±11.81）（t=10.116，P<0.001）。2例保髋失败，行全髋关节置换术（THA）。术后行动态增强MRI提示植骨及生物陶瓷棒植入区域血流信号良好。

结论

钻孔减压联合生物陶瓷棒植入在治疗ARCOⅡ、Ⅲ期以内股骨头坏死的短期随访疗效可靠，且ARCOⅡ期ONFH患者疗效更加显著。

关键词: 陶瓷, 股骨头坏死, 最小侵入性外科手术, 减压术,外科

Objective

To evaluate the clinical efficacy of bioceramic rod combined with recombinant human bone morphogenetic protein (rh-BMP) in the treatment of osteonecrosis of the femoral head (ONFH) at Association Research Circulation Osseuse (ARCO) stages Ⅱ and Ⅲ in young and middle-aged patients.

Methods

A total of 26 patients with ONFH admitted to the Department of Joint Surgery, the 940th Hospital of the Joint Logistics Support Force from January 2018 to June 2021 were enrolled. All the patients underwent bioceramic rod implantation combined with rh-BMP grafting. Preoperative and postoperative imaging findings, numerical rating scale (NRS) scores for pain, and Harris hip scores at preoperative and the last follow-up were recorded. Paired-samples t test was used for the comparison of indicators before and after surgery. Differences were considered statistically significant when P<0.05.

Results

The follow-up duration was 10 to 26 months, (18.0±1.6) months on average. The hip preservation rate was 92.8% (26/28) at the last follow-up. The NRS reduced from (4.07±0.26) to (1.50±0.92) (t=14.181, P<0.001) and the Harris hip score elevated from (60.00±6.24) to (85.54±11.81) (t=-10.116, P<0.001). Hip preservation failed in two patients, who subsequently underwent total hip arthroplasty (THA). Postoperative dynamic contrast-enhanced MRI showed good blood flow signals in the bone graft and bioceramic rod implantation areas in all the patients.

Conclusion

Core decompression combined with bioceramic rod implantation achieves reliable short-term efficacy in the treatment of ONFH at ARCO stages Ⅱ and Ⅲ, and the therapeutic effect is more prominent in patients with ARCO stage Ⅱ ONFH.

Key words: Ceramics, Femur head necrosis, Minimally invasive surgical procedures, Decompression, surgical

表1 ONFH患者术前术后评分对比［n=26，（

x ¯

±s）］

Table 1 Comparison of preoperative and postoperative scores in patients with ONFH

时间 Time	NRS	Harris髋关节评分 Harris hip score
术前 Before surgery	4.07±0.26	60.00±6.24
术后 After surgery	1.50±0.92	85.54±11.81
t值	14.181	10.116
P值	<0.001	<0.001

表1 ONFH患者术前术后评分对比［n=26，（

x ¯

±s）］

Table 1 Comparison of preoperative and postoperative scores in patients with ONFH

时间 Time	NRS	Harris髋关节评分 Harris hip score
术前 Before surgery	4.07±0.26	60.00±6.24
术后 After surgery	1.50±0.92	85.54±11.81
t值	14.181	10.116
P值	<0.001	<0.001

表2 ARCOⅡ与Ⅲ期患者术后血运优良率对比

Table 2 Comparison of postoperative blood supply excellent and good rate between ARCO stage Ⅱand Ⅲ

分期 Stage	例数 Case number	优 Excellent	良 Good	可 Fair	差 Poor	优良率（%）Excellent and good rate
Ⅱ期	21	12	7	2	0	90.5
Ⅲ期	7	4	1	0	2	71.4
P值						<0.001^a

表2 ARCOⅡ与Ⅲ期患者术后血运优良率对比

Table 2 Comparison of postoperative blood supply excellent and good rate between ARCO stage Ⅱand Ⅲ

分期 Stage	例数 Case number	优 Excellent	良 Good	可 Fair	差 Poor	优良率（%）Excellent and good rate
Ⅱ期	21	12	7	2	0	90.5
Ⅲ期	7	4	1	0	2	71.4
P值						<0.001^a

图1 左股骨头坏死保髋术后3个月骨盆正位X线片，示左股骨头密度不均匀，植入棒位置良好，陶瓷棒与股骨颈交界区域陶瓷出现吸收

Figure 1 X ray image of pelvis at anteroposterior view three months after hip preservation surgery for left femoral head osteonecrosis, showing uneven density of the femoral head, satisfactory position of the implanted ceramic rod, and ceramic resorption at the ceramic rod–femoral neck interface

图2 右股骨头坏死保髋术后10个月骨盆正位X线片，示右股骨头形态良好，右侧粗隆间可见条片状透亮区，陶瓷棒大部分被吸收

Figure 2 X ray image of pelvis at anteroposterior view 10 months after hip preservation surgery for right femoral head osteonecrosis，showing good morphology of right femoral head, strip-like radiolucency in the right intertrochanteric region, and almost complete resorption of the ceramic rod

图3 右股骨头坏死保髋术后17个月骨盆正位X线片，示股骨头光滑，骨小梁清晰，陶瓷棒基本吸收完全，成骨良好

Figure 3 X ray image of pelvis at anteroposterior view 17 months after hip preservation surgery for right femoral head osteonecrosis, showing a smooth femoral head contour, clear trabecular bone architecture, and complete resorption of the ceramic rod with favorable bone formation

图4 ARCO（国际骨循环研究协会）Ⅱ期保髋术后动态患侧术区增强MRI血流信号注：图A示分别在植骨区（区域1）、陶瓷棒隧道（区域2）、正常区（区域3）选取3个点；图B~C为未增强时3个点血流信号比较，示区域2及区域1血流信号较区域3明显增高；图D~E为增强后血流信号，示区域2及区域1血流信号较区域3明显增高

Figure 4 Dynamic contrast-enhanced MRI blood flow signals in the operative area of the affected side at ARCO stage Ⅱafter hip preservation surgery Note: A is the selection of three regions of interest (ROIs) , including bone graft area (area one), ceramic rod tunnel area (area two), normal area (area three); B to C are blood flow signals comparison among the three ROIs before contrast, showing significantly higher signals in areas two and one compared to area three; D to E are blood flow signals comparison after contrast, demonstrating higher signals in areas two and one compared to area three

图5 ARCO（国际骨循环研究协会）Ⅲ期保髋术后动态增强MRI血流信号注：图A示分别在植骨区（区域1）、陶瓷棒隧道（区域2）、正常区（区域3）选取3个点；图B为未增强时3个点血流信号比较，示区域2及区域1血流信号较区域3明显增高；图C为增强后同样显示区域2及区域1血流信号较区域3明显增高

Figure 5 Blood flow signals in dynamic contrast-enhanced MRI of ARCO stage Ⅲ hip preservation surgery Note: A is the selection of three regions of interest (ROIs) , including bone graft area (area one), ceramic rod tunnel area (area two), normal area (area three); B is blood-flow-signal comparison among the three ROIs before contrast, showing significantly higher signals in areas two and one compared to area three; C is blood-flow-signal comparison after contrast, demonstrating higher signals in areas two and one compared to area three

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