骨小梁钽金属棒植入治疗非塌陷股骨头缺血坏死

Trabecular metal tantalum rod implantation for avascular necrosis of the femoral head at pre-collapse stage

背景:骨小梁钽金属棒植入是早期非塌陷股骨头缺血坏死患者的一种新的治疗选择。目的:评估骨小梁钽金属棒治疗早期非塌陷股骨头缺血坏死的临床疗效及坏死股骨头的影像转归。方法:纳入2008-03/2009-08采用骨小梁钽金属棒植入治疗国际骨循环研究会分期Ⅰ、Ⅱ期股骨头缺血坏死患者7例,所有病例常规进行植入前后harris评分,X射线平片,核磁共振检查,术中取坏死组织活检。术后预防感染3d,患髋避免负重3个月。结果与结论:全部患者手术切口Ⅰ期愈合,无感染并发症,随访6～13个月。患者术后疼痛症状明显缓解,术前harris评分(65.4±3.1)分,术后2周平均(72.6±2.9)分、10个月平均(81.3±3.5)分,与术前比较,差异有显著性意义(P<0.05)。影像学结果显示7例患者钽棒位置良好,6例患者坏死股骨头无塌陷,1例在术后4个月出现塌陷,但8～12个月塌陷并未加重,疼痛持续缓解。提示,骨小梁钽金属棒植入能有效延缓股骨头缺血坏死病程,缓解患者疼痛症状及提高髋关节功能。钽棒植入后仍然可能存在股骨头塌陷,但塌陷程度较轻并趋于停止,可能与假体植入位置和股骨头坏死范围相关。

BACKGROUND：Trabecular metal tantalum rod implantation is a novel treatment for patients with avascular necrosis of the femoral head at pre-collapse stage. OBJECTIVE：To investigate the clinical efficacy of trabecular metal tantalum rod implanted for avascular necrosis of the femoral head at pre-collapse stage and the radiology outcomes of necrotic femoral head. METHODS：From March 2008 to August 2009,7 patients with avascular necrosis of the femoral head at Association Research Circulation Osseous stage I and stage II were treated by trabecular metal tantalum rod implant. Harris score,X-ray and MRI were performed pre-and post-operatively. Necrotic tissue obtained by surgery was subjected to pathology. Antibiotics were applied for 3 days postoperatively,and affected limbs should avoid full weight-bearing in 3 months. RESULTS AND CONCLUSION：All incisions healed at primary stage with no infection or other postoperative complications. All 7 cases were followed up for 6-13 months. After tantalum rod implantation,the pain symptom of all cases mitigated significantly. The Harris score was 72.6±2.9 at 2 weeks and 81.3±3.5 at 10 months postoperation,showing a significant difference compared with preoperative score （65.4±3.1,P 0.05）. Postoperative X-ray showed that all 7 tantalum rods were well placed. Necrosis of the femoral head in 6 patients did not progress. One case presented with collapse at 4 months after surgery,but collapse did not increase at 8-12 months with sustained pain relief. Trabecular metal tantalum rod implantation can effectively delay the progression of avascular necrosis of the femoral head,relieve pain and improve functionality of affected hip. Collapse can also occur at prosthetic implanted femoral head but at a less extent and tends to stop. This may be related to the location of rod and the extent of femoral head necrosis.