多孔金属钽棒治疗早期股骨头坏死的近期疗效观察

The early clinical observation of treatment of osteonecrosis of the femoral head with porous metal tantalum rod

目的探讨多孔金属钽棒治疗早期股骨头坏死(ONFH)的临床效果。方法对应用多孔钽棒治疗的15例早期ONFH患者临床资料进行回顾性研究。按照国际骨循环研究会(ARCO)分类的ONFH病变Ⅰ、Ⅱ期患者共15例(15髋),术后3、6、12、24个月时随访。临床评价Harris评分、X线片病情及骨长入情况。结果 Harris评分术前与术后3、6、12、24个月比较差异均有统计学意义(P=0.000)。手术前、后X线片分期比较,术后12个月2例ⅡB期进展为ⅡC期,24个月2例ⅡC期进展为Ⅲ期,股骨头塌陷,需行全髋关节置换术。4例可见原有囊性变区内骨密度增高表现,1例在钽棒周围出现"骨锚固征"。结论多孔金属钽棒对ONFHⅠ期病变治疗改善率最佳,ⅡA、ⅡB期改善率次之,ⅡC期改善率最低,对Ⅰ、ⅡA、ⅡB期病变可有效防止股骨头塌陷。

Objective To explore the effect of the porous metal tantalum rod in the treatment of the osteonecrosis the femoral head（ONFH）. Methods The clinical data of 15 patients with ONFH stage I , Ⅱ graded by the Interr tional Bone Cycle Research Council（ Association Research Circulation Osseous, ARCO）were studied retrospectivel Harris score,X-ray films and bone ingrowth condition were assessed at 3,6,12,24 months after operation respectk ly. Results There was significant differences between Harris scores at pre-operation and post-operation （ P = 0. 000 Assessed by X-ray,2 cases with stage ⅡB progressed to Ⅱ c at 12 months after operation and 2 cases withⅡ c Progressed to Ⅲ at 24 months. The later 2 patients＇ femoral head collapsed and needed to be treated with THA. Increas BMD performance in original cystic changes area had been seen in 4 patients and＂ bone anchorage levy＂ around tan1 lure bar occured in 1 patient. Conclusions The clinical effect of porous tantalum is best for patients with ONt stage I ~ The result is moderate for ONFH Ⅱ A and Ⅱ B and poor for ONFH Ⅱ c. Porous tantalum can effectively prevent femoral head collapse in patients with ONFH I , Ⅱ A and ⅡB .