钽棒治疗早期股骨头坏死的近期疗效评价与分析

Short term efficacy evaluation and analysis of the treatment for early-stage osteonecrosis of the femoral head with Tantalum Rod

目的评价钽棒植入术治疗早期股骨头坏死(ONFH)的近期疗效,探讨钽棒植入的适应证及禁忌证。方法 2008年6月至2010年10月,采用钽棒植入术治疗早期股骨头坏死共58例63髋,全部获得随访,平均随访时间(16·03±8·16)个月(6～34个月)。年龄17～61岁,平均年龄(37·43±10·3)岁。按ARCO分期:Ⅰ期1髋,Ⅱ期45髋,不稳定型Ⅱ期12髋,Ⅲ期5髋。术前改良正位分型C1、C2分别为41、9髋。坏死范围按改良坏死范围指数≤33:17髋;34～66:25髋;≥67:21髋。术前Harris评分平均为(87·80±15·50)分。结果术后均无钽棒本身相关的并发症发生;末次随访Harris评分平均为(98·96±4·19)分;以股骨头塌陷>4mm为终点事件,术后随访24个月的生存率为77·78%。Kaplan-Meier生存分析提示Ⅱ期、不稳定型Ⅱ期的生存率分别为84·4%、58·3%,经Log-rank检验差异已经达到检验效能;改良正位分型C1、C2的生存率分别为85·37%、11·1%,经Log-rank检验差异有统计学意义(χ2=31·35,P<0·001);坏死范围的生存率:≤33组为94·1%,34～66组为96·0%,≥67组为42·9%,经Log-rank检验差异有统计学意义(χ2=16·07,P<0·01)。结论钽棒植入术是治疗早期股骨头坏死的有效手段,适应证为改良坏死范围指数<67或改良正位分型C1型以下的ARCOⅠ期及稳定型Ⅱ期患者。

Objective To evaluate the short-term efficacy of tantalum rod implantation treating early-stage osteonecrosis of the femoral head （ONFH） and discuss the indications and contraindications of tantalum rod implantation. Methods Patients who suffered from ONFH and received tantalum rod implantation from June 2008 to October 2010, were followed up. The mean follow-up time of 58 cases （63 hips） with early-stage ONFH treated with tantalum rod implant was （16. 03 ± 8.16） months （6-34 months） , and the average age was （37.43 ± 10. 3） years. Staged by ARCO, there were one hip in stage 1 , 45 hips in stage 11 , 12 hips in unstable stage Ⅱ , and five hips in stage Ⅲ. By preoperative modified anteroposterior classification, 41 hips were type C1, and nine hips were type C2. Classified by modified index of necrotic extent, 17 hips were below 33, 25 hips were between 34-66, and 21 hips were over 67. The average preoperative Harris score was （ 87. 80 ± 15.50 ）. Results No complications related to tantalum rod occured after operation. Harris score in the last follow-up was （98.96± 4. 19 ）. Using the femoral head collapse 〉4 mm as the endpoint, the survival rate was 77. 78% at the follow-up time of 24 months. Kaplan-Meier survival curve showed the survival rate was 84. 4% in stage Ⅱ and 58.3% in unstable stage Ⅱ. The survival rate in type CI of modified anteroposterior classification was 85.37%, and 11.1% in type C2, and there was a significant difference between them applying Log-rank test （Х^2 = 31.35, P 〈 0. 001 ）. As for necrosis extent： in group below 33 the survival rate was 94. 1% , in group between 34-66 it was 96. 0%, and in group over 67 it was 42. 9% （ Х^2 = 16. 07 ,P 〈 0. 01 ）. Conclusions Tantalum rod implantation is an effective method to treat early stage ONFH, and the indications are ARCO stage I and stable stage Ⅱ that the modified index of necrotic extent below 67, or type C1 and under type C1 in modified anteroposterior classification.