髓芯减压与钽棒植入治疗早期股骨头坏死的比较

Long-Term Efficacy of Core Decompression Versus the Porous Metal Tantalum Rod for Femoral Head Necrosis

目的:对比多孔髓芯减压与钽金属棒治疗早期股骨头坏死的临床疗效。方法:将早期股骨头坏死患者(29例36个髋)随机分为2组。髓芯减压组(17例22个髋)采用多孔髓芯减压治疗,钽棒组(12例14个髋)采用多孔钽金属棒治疗。术后3月、6月、12月随访,比较2组病例髋关节功能Harris评分和视觉模拟疼痛评分(VAS)。于末次随访时,根据ARCO分期和坏死面积大小进行VAS评分及Harris评分。结果:所有患者均获得随访,随访时间6～12个月,平均10.5个月。术后3月、6月、12月2组患者VAS评分均较术前明显降低(P<0.05),髋关节功能Harris评分均较术前明显提高(P<0.05)。相同随访时间点2组VAS评分和Harris评分均无显著性差异(P>0.05)。末次随访时ARCOⅡb期、Ⅲ期患者VAS评分明显高于Ⅰ期、Ⅱa期患者,髋关节功能Harris评分明显低于Ⅰ期、Ⅱa期患者(P<0.05)。股骨头坏死面积<25%患者VAS评分明显低于坏死面积>25%患者,髋关节功能Harris评分明显高于坏死面积>25%患者(P<0.05)。结论:多孔髓芯减压和钽金属棒治疗早期股骨头坏死均有效,但ARCOⅡb期、Ⅲ期及股骨头坏死面积>25%患者预后欠佳。

Objective： To compare the long-term efficacy of core decompression versus the porous metal tantalum rod for femoral head necrosis.Methods： 29 patients with femoral head necrosis including 20 males and 9 females were randomly divided into two groups： patients in core decompression group were treated with core decompression,other in tantalum rod group were treated with porous metal tantalum rod.Clinical functional recovery based on Harris score and VAS score;results were compared in the two groups;Harris score and VAS score were also compared on ARCO stagings and the scope of necrosis.Results： All patients were followed up for 6 to 12 months with the mean of 10.5 months.The postoperative VAS scores of hip joint were significantly lower than preoperative VAS score（P 0.05）.The postoperative Harris scores were significantly higher than preoperative Harris score（P 0.05）.VAS scores in Ⅱ b and Ⅲ patients were significantly higher,Harris scores were significantly lower than those in Ⅰand Ⅱb patients.VAS scores in patients with the necrosis area of femoral head 25% were significantly higher,Harris scores were significantly lower than those in patients with the necrosis area of femoral head 25%.Conclusion： Core decompression and the porous metal tantalum rod are both effective for early femoral head necrosis.Patients in ARCO Ⅱb and Ⅲ period or the necrosis area of femoral head 25% had poor prognosis.