钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死

Tantalum rod insertion combined with vascularized pedicled iliac graft in the treatment of early-stage femur head necrosis for young and middle-aged

目的探讨钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死的临床疗效。方法回顾性分析2007年10月至2012年1月中山大学附属江门医院采用钽棒植入联合带血管蒂髂骨瓣转移治疗的11例（15髋）中青年早期股骨头坏死患者的临床资料，记录手术时间、术中出血量，观察内置钽棒松动、断裂及症状改善情况，末次随访时进行髋关节Harris评分和影像学检查。结果11例患者随访12~60个月（平均24个月）。手术时间60～100min（平均70min）、术中出血量200~400mL（平均280mL）。随访期间内置钽棒未见松动、断裂，未出现钽棒排斥反应。患髋疼痛感减轻或消失，末次随访时Harris评分为（85士4）分，较术前的（62士3）分明显提高（f=6．505，P=O．000）。影像学检查未见股骨头塌陷，植骨区域未出现骨坏死趋势。结论钽棒植入联合带血管蒂髂骨瓣转移手术可改善血供，提供足够的力学支持，有效防止股骨头进一步塌陷，临床功能改善效果较理想，是治疗中青年早期股骨头坏死的有效方法。

Objective To study the clinical outcome of tantalum rod insertion combined with vascularized pedicled iliac bone graft in the treatment of early-stage osteonecrosis of the femoral head for young and middle-aged. Methods Clinical data of 11 patients （t5 hips） with early-stage femur head necrosis were collected and analyzed retrospectively, those patients were treated by tantalum rod insertion combined with vascularized pedicled iliac bone graft from October 2007 to January 2012 in affiliated Jiangmen Hospital of Zhongshan University. Operative time, estimate blood loss were recorded, tantalum rod loosening, breakage as well as the improvement of symptom after the surgery were observed, and Harris scores of hip joint and radiological results were evaluated at the last follow-up. Results All patients were followed up for 12-60 months, with the average of 24 months. The average surgical time was 70 minuties （60 to 100 min）, and the average estimate blood loss was 280 mL （200-400 mL）. Pain of hip relieved or resolved, the Harris score at the last follow-up （85± 4） was higher than the preoperative one （62±3）, the difference had statistical significance （t = 6.505, P = 0.000）. Radiographs showed that no femoral head collapse occurred, and there were no bone necrosis tendency in the area of bone graft. During the follow-up, no tantalum rod loosening or breakage were found, and no internal fixator rejection reaction had happened. Conclusion Tantalum rod insertion combined with vascularized pedicled iliac bone graft is an effective method for early-stage osteonecrosis of the femoral head because it can improve blood supply and also can provide enough mechanical support, so as to prevent the progress of femoral head collapse and to get satisfied effect of function improvement.