钽棒治疗早期非创伤性股骨头坏死的回归性研究

Regressive analysis of porous tantalum implant in treating osteonecrosis of the femoral head

[目的]分析钽棒治疗早期股骨头坏死的临床疗效,探讨影响钽棒治疗早期股骨头坏死临床疗效的因素。[方法]钽棒治疗早期股骨头坏死病例149例(168髋),男96例,女53例;平均年龄32.36岁。Ⅰ期和Ⅱ期(塌陷前)88髋,Ⅲ期(塌陷后)80髋,其中双侧19例。根据ARCO分期,进行Harris评分和影像学评估。将Harris评分70分以下、再次手术、影像学病变进展(股骨头由非塌陷变塌陷或塌陷加重,关节间隙狭窄加重)视为钽棒失败。[结果]共随访到130例138髋,平均随访时间(31.47±5.78)(8～61)个月,术前平均Harris评分为62.65,术后为79.50(P<0.05)。优良率为68.12%。Cox风险模型分析显示大病灶、外侧病灶、植骨与否是手术失败的风险因素,病因、性别、年龄、病灶是否在股骨头骺板内,对钽棒治疗早期股骨头坏死的临床疗效无明显影响。[结论]影响钽棒治疗早期股骨头坏死临床疗效的因素是病灶大小(大于30%)、坏死灶位置(外侧型)、植骨与否,钽棒治疗早期股骨头坏死需要清除死骨、联合植骨。

[ Objective ] To evaluate the clinical results and radiographic outcomes of porous tantalum implant in osteonecrosis of the femoral head （ONFH） . [ Methods] Totally 149 ONFH （168 hips ） were treated with porous tantalum implant. Evaluation included Harris score, radiography, and clinical outcomes. Revision was the end point of porous tantalum implant. [ Results] Totally 130 patients （ 138 hips） were available for follow - up at a mean of 31.47 ±5.78 months. According to analysis of COX risky model, size of lesion, location of lesion, bone graft were independent risk factors for failure. [ Condusion] The survival rate of porous tantalum implant in treatment of early stage osteonecrosis of the femoral head is affected with size of lesion, location of lesion , and bone graft.