纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗部分塌陷股骨头坏死的失败原因分析

Failure analysis of nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone in treatment of partially collapsed osteonecrosis of the femoral head

目的:分析纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗已发生部分塌陷的股骨头坏死(ONFH)患者的临床疗效,总结失败原因,进一步探讨该手术方法的适应证。方法:回顾性纳入2016年7月至2020年11月行纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗部分塌陷ONFH患者68例76髋。采用Harris髋关节评分(HHS)评估髋关节功能,CT和X线检查评估影像学变化,以行全髋关节置换术(THA)或HHS评分<70分被认为临床失败。结果:68例76髋全部获得随访,随访时间6~53个月,平均(28.3±10.2)个月。HHS评分由术前的(73.6±11.0)分提高至末次随访的(82.0±17.8)分,差异有统计学意义(P<0.001)。髋关节功能优良率由术前的26.3%提高至末次随访时的64.5%,差异有统计学意义(P<0.001)。术后所有患者均未发生手术相关并发症。末次随访时21髋临床失败,总失败率为27.6%,单因素和多因素分析显示日本骨坏死研究会(JIC)分型是影响纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗已发生部分塌陷的ONFH患者的危险因素(P<0.05)。结论:纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗部分塌陷ONFH失败的原因与年龄、性别、术前HHS评分、ARCO分期、病因等无关;而JIC分型对判断愈后有一定的预测性,JIC C2型患者的失败率较高;针对部分塌陷ONFH患者,JIC C1型符合纳米羟基磷灰石/聚酰胺66支撑棒结合同种异体骨治疗部分塌陷ONFH患者的手术适应证。

Objective:To analyze the clinical efficacy of nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone in treatment of partially collapsed osteonecrosis of the femoral head(ONFH),summarize the causes of failure,and further explore the indications of this surgical method.Methods:From July 2016 to November 2020,68 patients(76 hips)with partially collapsed ONFH treated with nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone were enrolled in this study.Hip function was assessed by Harris hip score(HHS),radiographic changes were assessed by CT and X-ray,and total hip arthroplasty(THA)or HHS less than 70 was used to judge clinical treatment failure.Results:All patients were followed up for 6-53 months with a mean of(28.3±10.2)months.HHS increased from(73.6±11.0)before surgery to(82.0±17.8)at the last follow-up(P<0.001).The excellent and good rate of hip function increased from 26.3%before operation to 64.5%at the last follow-up(P<0.001).No patient had surgical related complications after operation.At the last follow-up,21 hips failed clinically,with a total failure rate of 27.6%.Univariate and multivariate analysis showed that Japanese Investigation Committee(JIC)typing was a risk factor for the treatment of partially collapsed ONFH patients with nano-hydroxyapatite/polyamide 66 brace combined with allogeneic bone.Conclusions:Age,gender,preoperative HHS,ARCO stage and etiology are not considered as reasons for failure of the poeration with nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone in treatment of partial collapsed ONFH.The JIC typing has a certain degree of prediction on the prognosis.JIC C2 type patients have a higher failure rate,and JIC C1 patients are optimal target for nano-hydroxyapatite/polyamide 66 bracing rod combined with allogeneic bone.