髓芯减压钽棒+自体骨植入治疗成人早期股骨头缺血性坏死的短期疗效观察

Outcome after tantalum rod implantation combined with core decompression for early stage adult avascular necrosis of femoral head

目的通过对髓芯减压联合多孔钽棒+自体骨植骨植入术后临床和影像学结果进行回顾性分析,探讨该方法治疗成人早期缺血性股骨头坏死(ANFH)的短期疗效。方法选定Ficat分期Ⅰ-Ⅱ期成人ANFH患者11例(17髋),男10例,女1例,平均年龄为39.2(21-58)岁。手术方式为髓芯减压联合多孔钽棒+自体骨植入。随访时间为12-21月。对手术前、后Harris评分进行配对t检验及患肢股骨头的影像学改变进行观察评估,得出术后12个月的股骨头生存率。结果 2例(3髋)失随访。随访9例14髋中,手术前及术后12个月患髋关节Harris评分分别为(56.93±4.93)分和(77.21±5.82)分(P<0.05),差异有显著性;影像学X线片复查3例(3髋)有所加重,其中1例(1髋)已在术后14个月在外院行髋关节置换术。以股骨头塌陷或全髋关节置换为研究止点,股骨头生存率为78.6%。结论髓芯减压联合多孔钽棒+自体骨植入治疗早期股骨头坏死(Ficat分期,Ⅰ-ⅡB期),短期观察,髋关节功能改善较明显,是一种较为有效的股骨头坏死早期保头治疗的方案。

Objective To evaluate the clinical and radiological outcomes of adult avascular necrosis of femoral head（ANFH） at early stage after implantation of Porous tantalum rod and autograft bone combined with core decompression.Methods A total of 11 cases of ANFH（Ficat stageⅠ-Ⅱ） were enrolled,10 male and 1 female,averaged 39.2（21-58） years.Porous tantalum rod and autograft bone combined with core decompression was implanted.All patients were followed up for 12-21 months.Patients were evaluated radiologically and clinically using the outcome of Harris hip score（HHS）.The survival of femoral heads 12 months after operation was eva-luated by X-ray.Results All patients except for 2 patients（3 hips） were followed up.The mean HHS was 56.93±4.93 before operation,but 77.21±5.82 at month 12 after operation（P〈0.05）.Of 14 hips,11 hips remained at the same radiographic stage,and 3 hips deteriorated.One patient（1 hip） underwent the total hip arthroplasty（THA） at month 14 after operation.With THA as the observation endpoint,the survival rate of femoral head was 78.6%.Conclusion Implantation of Porous tantalum rod and autograft bone combined with core decompression has a significant effect on hip function initially in most hips,and could be an effective technique in the treatment of adult ANFH at early stage.