多孔钽棒植入治疗股骨头坏死的适应证及临床疗效观察

The indication and clinical results of porous tantalum rod for femoral head necrosis

目的探讨多孔钽棒植入治疗股骨头坏死的适应证并观察其临床疗效。方法2008年5月至2008年11月,治疗股骨头坏死患者25例29髋,男14例17髋,女11例12髋;年龄29～48岁,平均36岁;根据Steinberg分期:Ⅰ期10髋,Ⅱ期16髋,Ⅲ期3髋。采用侧方小切口入路,行髓心减压及多孔钽棒植入术。术后3周内禁止负重,3周后可部分负重,然后逐步过渡至完全负重。采用Harris评分系统评估术后患髋功能的改善情况;术后3、6、12个月摄正、侧位X线片,观察股骨头修复情况及有无坏死进展。结果23例27髋获得随访,随访时间12～18个月,平均15个月。术后12个月或末次随访进行疗效评估,优:17例19髋,良:4例5髋,可:2例3髋。患者的Harris评分由术前的49～83分,平均(65.3±8.6)分,提高至术后的75～100分,平均(88.2±9.3)分(P<0.001)。Ⅰ期由术前70～83分,平均(73.7±5.6)分,提高至术后79～100分,平均(94.5±6.4)分;Ⅱ期由术前51～72分,平均(63.4±6.1)分,提高至术后76～99分,平均(87.1±9.0)分;Ⅲ期由术前49～65分,平均(56.8±7.3)分,提高至术后74～89分,平均(81.7±8.2)分。各组提高分数之间显著差异。髋关节影像学表现稳定,股骨头无坏死进展。结论髓心减压及多孔钽棒植入术治疗股骨头缺血性坏死适合于SteinbergⅠ、Ⅱ期及较小塌陷的Ⅲ期股骨头坏死患者。

Objective To investigate the indication of porous tantalum implant for treating femoral head necrosis and analyze its clinical results. Methods From May 2008 to December 2008, 25 patients （29 hips） who had undergone core decompression in combination with porous tantalum implant in our hospital were involved in this study. Steinberg I stage were 10 hips, II stage were 16 hips, and III stage were 3 hips. Postoperative care consisted of prophylactic intravenous antibiotic and anticoagulation therapy. Patients were instructed to be non-weight- bearing for 3 weeks, to partialweight-bear for the next 3 weeks, and to weight bear as tolerated thereafter. All patients were evaluated both clinically and radiographically. The functional improvement was assessed with the Harris hip score. Serial anteroposterior and lateral radiograms of the pelvis were taken at 3, 6, 12 months post-operatively to analyze the process of osteonecrosis. Results Totally 23 patients （27 hips） were followed up and the duration continued 12 - 18 months with an average of 15 months. According to the Harris hip score system, ＂excellent＂ for 19 hips, ＂good＂ for 5 hips, ＇＂ fair＂ for 3 hips. The mean preoperative score was 65.3, post-operative score was 88.2, with a mean improvement of 22. 9 points （P 〈0. 001）. The mean preoperative score of Steinberg I , II and III improved from 73.7 to 94. 5, 65.4 to 87.1, 56. 8 to 81.7 ; with a mean improvement of 22. 9 points 20. 7, 24. 3, 24. 9 respectively （ P 〉 0. 001 ）. Radiological changes coincided with clinical changes. Conclusion Core decompression in combination with porous tantalum implant provides a minimally in- vasive surgical treatment option to treat osteonecrosis of femoral heads （ Steinberg stage I and II, and III with small collapse） and to prevent femoral heads from collapsing.