三维"C"型臂X线定位多孔钽金属棒植入治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死

Clinical effects of the implantation of porous tantalum rod under three-dimensional C-arm positioning in treating ARCOⅠ-Ⅱnon-traumatic necrosis of the femoral head

目的探讨三维"C"型臂X线定位多孔钽金属棒植入治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死的临床疗效.方法2009年1月至2011年12月接受多孔钽金属棒植入治疗的ARCOⅠ-Ⅱ期非创伤性股骨头坏死患者50例(58髋),男39例,女11例;年龄(33.52±1.44)岁(范围21~51岁).术中采用三维"C"型臂X线定位24例(29髋)、"C"型臂X线定位26例(29髋).术后0.5、1、2、4年随访,评估疼痛视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分及优良率,以髋关节置换为终点计算股骨头生存率.结果三维"C"型臂X线定位组疼痛VAS评分由术前(7.17±1.00)分降低至术后0.5年(2.38±0.86)分、1年(2.10±1.40)分、2年(2.38±1.66)分、4年(2.21±1.47)分,差异有统计学意义(F=98.78,P=0.00);Harris评分由术前(73.97±3.49)分提高至术后0.5年(89.90±1.93)分、1年(89.93±3.26)分、2年(89.21±5.83)分、4年(88.57±5.70)分,差异有统计学意义(F=84.35,P=0.00).术后4年,23髋未见ARCO分期进展、4髋由ARCOⅡ期进展至Ⅲ期、2髋由ARCOⅠ期进展至Ⅱ期,手术成功率79%(23/29);2髋接受全髋关节置换术,股骨头生存率93%(27/29)."C"型臂X线定位组VAS评分、Harris评分变化趋势同三维"C"型臂X线定位组,各时点VAS评分及Harris评分的组间差异均无统计学意义(P>0.05).三维"C"型臂X线定位组手术时间、术中出血量、钽金属棒距离股骨头坏死灶中心的距离分别为(31.38±3.96)min、(36.72±5.59)ml、(0.18±0.07)cm,均小于"C"型臂X线定位组[分别为(41.97±4.64)min、(41.49±4.46)ml、(0.23±0.10)cm],钽金属棒在冠状面上至股骨颈两端的距离比值(0.48±0.10)大于"C"型臂X线定位组(0.46±0.06),差异有统计学意义(P<0.05).结论多孔钽金属棒植入治疗早期非创伤性股骨头坏死可以改善髋关节功能、缓解症状、延缓影像学进展,应用三维"C"型臂X线定位多孔钽金属棒植入可提高操作的精确性和安全性.

Objective To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional(3D)C-arm positioning in the treatment of ARCOⅠandⅡnon-traumatic femoral head necrosis.Methods Fifty patients(58 hips,39 males and 11 females,mean age 33.52 years)with non-traumatic femoral head in ARCOⅠ-Ⅱwere included from January 2009 to December 2011.All patients received implantation of porous tantalum rod.The 3D C-arm X-ray positioning was used in 24 patients(29 hips),while traditional C-arm X-ray positioning was performed in the other patients.The visual analogue scale(VAS),Harris score and superior rate were evaluated at 0.5,1,2,and 4 years after the surgery.Total hip arthroplasty was regarded as the end event for survival rate.Results In the 3D C-arm X-ray positioning group,the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year,to 2.10±1.40 points at 1 year,to 2.38±1.66 points at 2 years,and to 2.21±1.47 points at 4 years postoperatively(F=98.7&P=0.00).Meanwhile,the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93,89.93±3.26,89.21±5.83,88.57±5.70 points at the follow up,respectively(F=84.35,P=0.00).According to the analysis of the pre-operative and post-operative image data,there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up.Four hips were developed to ARCOⅢand two hips to ARCOⅡ.Thus,the success rate of operation was 79%(23/29).There were two hips underwent total hip arthroplasty,so the survival rate of femoral head was 93%(27/29).The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference(P>0.05).The operation duration 31.38±3.96 min,blood loss 36.72±5.59 ml,the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10,and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group(respectively 41.97±4.64 min,41.49±4.46 ml,0.46±0.06,0.23±0.10 cm,P<0.05).Conclusion The implantation of tantalum rod in treating ARCO Ⅰ-Ⅱ non-traumatic femoral head necrosis can increase the function of hip joint,relieve the symptoms of necrosis of femoral head,alleviate the progress of femoral head necrosis in X-ray,and obtain a higher survival rate.The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery.