多孔钽棒联合植骨治疗成年股骨头坏死的临床研究

Clinical research of porous tantalum rod jointing bone implantation for the treatment of adult femoral head necrosis

目的:探讨多孔钽棒联合自体骨植入治疗成年股骨头坏死的临床疗效及应用优势。方法:采用前瞻性方案,将37例(43髋)成年股骨头坏死患者随机分为两组,对照组采用髓芯减压联合多孔钽棒植入进行治疗,观察组在对照组基础上进行适量的自体骨移植,对比临床手术情况;同时,随访术后恢复情况,对比手术前后的疼痛评分和髋关节功能评分,并行影像学复诊,观察股骨头进展性坏死和塌陷情况。结果:观察组患者的手术时间较长,术中出血量较多,较对照组相比有统计学意义(P<0.05)。时间与组别对患者的疼痛与功能评分均有影响(P<0.01);治疗后水平低于治疗前水平,观察组降低幅度高于对照组降低幅度;且组别和时间之间不存在交互作用(P>0.05)。此外,两组患者的术后塌陷率无统计学意义(P>0.05),但观察组术后进展性坏死发生率显著低于对照组(P<0.05)。结论:多孔钽棒联合自体骨植入治疗成年股骨头坏死,创伤小、操作简单、疗效可靠,具有较高应用价值。

Objective： To explore the clinical effect and application value of porous tantalum rod jointing bone implantation for the treatment of adult femoral head necrosis. Methods： 37 patients（ 43 hip-joints） were divided into 2 groups randomly according to a forward-looking method. The controls were treated with medullary decompression jointing porous tantalum implantation,and those in the observation group were give autologous bone implantation at the same time. The clinical operation status and postoperative recovery status were observed,and the pain score,hip function score,subsequent necrosis and subside situation were recorded. Results： Patients in observation group had longer operation time and more bleeding than the controls（ P〈0. 05）. Before treatment,there was no significant difference in pain score and knee function between groups（ P〉0. 05）. After treatment,patients of the observation group had lower pain score and higher hip function score,which were all significantly different to the controls（ P〈0. 01 or P〈0. 05）. Further more,the postoperative subsidence rate had no significant difference between groups（ P〉0. 05）,but the subsequent necrosis rate of the observation group was lower than the controls（ P〈0. 05）. Conclusion： There is high application value for porous tantalum rod jointing bone implantation in the treatment of adult femoral head necrosis,with small trauma,simple operation and reliable curative effect.