髓心减压植骨与钽棒植入治疗股骨头缺血性坏死

A Comparative Study for the Treatment of Necrosis of the Femoral Head of Core Decompress with Bone Graft or Tantalum Screw

目的研究比较髓心减压植骨与钽棒植入治疗股骨头缺血性坏死的临床疗效。方法选择2008年5月至2010年3月我院收治的成人股骨头缺血坏死患者(均为Ficat期)26例(31髋),男19例,女7例;年龄24～63岁(平均41.3岁)。其中15例(19髋)采用髓心减压植骨术治疗,11例(12髋)采用髓心减压钽棒植入术治疗。记录两种术式的失血量、手术时间、输血量、住院天数、Harris评分和镇痛泵的使用天数。结果所有病例均获得术后随访4～24个月,两组术中失血量、手术时间、输血量、镇痛泵的使用天数比较差异无统计学意义,而住院天数髓心减压钽棒植入组明显长于髓心减压植骨组(P<0.05)。两组术前Harris评分比较没有统计学意义,两组术后Harris评分较术前均有明显提高(P<0.05),术后Harris评分髓心减压钽棒植入组(88.24分)高于髓心减压植骨组(71.84分),提高22.8%,数据差异有统计学意义(P<0.05)。结论髓心减压钽棒植入术对早期成人股骨头坏死髋关节功能改善明显优于髓心减压植骨术,但住院天数较长。

Objective To study the clinical outcome of core decompress with bone graft or tantalum screw insertion for the treatment of necrosis of the femoral head.Methods 26 cases（31 hips） of Ficat stage Ⅱ necrosis of the femoral head,from May 2008 to March 2010,were studied,including 19 males and 7 females.The average age was 41.3（24～63） years.15 cases（19 hips） underwent core decompress with bone graft while 11 cases（12 hips） received tantalum screw insertion.The Harris score,intraoperative blood loss,surgical time,blood transfusions,PCA pump usage and hospital days were evaluated.Results All cases were followed up 4 to 24 months（average 15 months）,there was no statistical difference between two groups in intraoperative blood loss,surgical time,blood transfusions,PCA pump usage and Harris score of preoperative.There was statistical difference between two groups in hospital days（P0.05）,but in-hospital time of tantalum screw insertion is longer than those of core decompress with bone graft.The Harris score of both groups was obviously increased postoperatively（P0.05）.The average Harris score of tantalum screw insertion group（88.24） was increased by 22.8% than that of core decompress with bone graft（71.84）,there was statistical difference between two groups（P0.05）.Conclusion Compared with the core decompress with bone graft,tantalum screw insertion shows more satisfactory result in the function of hip and range of motion,but in-hospital time of tantalum screw insertion is longer than those of core decompress with bone graft.