多孔涂层钽金属棒系统治疗早期非创伤性股骨头坏死的临床对比研究

doi:10.3877/cma.j.issn.2096-0263.2018.05.004

目的

对比分析保守治疗与髓芯减压多孔钽棒植入术治疗早期非创伤性股骨头坏死患者的短、中期疗效。

方法

回顾性收集2012年6月至2017年1月青岛大学附属医院关节外科收治的60例股骨头坏死患者（80髋）。根据治疗方式的不同分为保守治疗组（保守组，30例40髋）与髓芯减压多孔钽棒植入术（钽棒组，30例40髋）。观察两组患者术后并发症及患肢功能、Harris评分、影像学分析内植物状态、绘制股骨头生存曲线。

结果

保守组获得随访27例（36髋），失访3例（4髋），钽棒组获得随访20例（27髋），失访10例（13髋），平均随访时间为（26±6）个月（3~62个月）。两组Harris评分比较：保守组和钽棒组治疗前、治疗后12个月、末次随访进行重复测量设计的方差分析显示，两组间差异有统计学意义（F=3046.153，P<0.001），组别与时间点间存在交互作用（F=5883.563，P<0.001），各时间点除治疗前外，差异均有统计学意义；钽棒组各时间点间的差异有统计学意义（F=2563.841，P<0.001）。两组生存曲线比较，差异有统计学意义（Log rank=87.432，P<0.001）。

结论

多孔涂层钽金属棒植入可获得较好的短、中期疗效，优于保守治疗。

关键词: 钽, 内固定器, 股骨头坏死

Objective

To compare the effect of the porous coating tantalum rod implant and conservative treatment in early and mid-time of early nontraumatic femoral head necrosis.

Methods

A retrospective study of sixty femoral head necrosis patients with 80 hips admitted to the department of Joint Surgery, Affiliated Hospital of Qingdao University from June 2012 to January 2017 were conducted. According to the different treatment methods, they were divided into conservative treatment group (conservative group, 30 cases, 40 hips) and core decompression porous tantalum rod implantation (tantalum rod group, 30 cases, 40 hips). Postoperative complications, radiological assessment and clinical using the Harris hip score were evaluated.

Results

In the conservative group, 27 cases (36 hips) were followed up, 3 cases (4 hips) were lost, 20 cases (27 hips) were followed up in tantalum rod group, 10 cases (13 hips) missed. The mean follow-up time was 26±6 months (3 to 62 months). Harris score of conservative group and tantalum rod group before treatment, 12 months after treatment and last follow-up were analyzed through repeated measurement design analysis of variance showing that there was significant difference between the two groups (F=3046.153, P=0.000), there was interaction between groups and time points (F=5883.563, P=0.000), the differences of each time point except the first time point were statistically significant; the difference between the tantalum rod group and the other two groups was statistically significant at each time point (F=2563.841, P=0.000). Two groups had difference in survival analysis (Log rank=87.432, P<0.001).

Conclusion

The porous coating tantalum implant could bring better short-intermediate term effect than conservative group.

Key words: Tantalum, Internal fixators, Femur head necrosis

表1 钽棒组与保守组一般资料比较

组别	年龄（岁，±s）	股骨头病变分期（FicatⅠ期/FicatⅡ期）	侧别（左/右/双侧）
钽棒组	50±5	10/20	15/5/10
保守组	50±7	7/23	15/5/10
t值	1.321	1.589	1.935
P值	0.189	0.132	0.798

表1 钽棒组与保守组一般资料比较

组别	年龄（岁，±s）	股骨头病变分期（FicatⅠ期/FicatⅡ期）	侧别（左/右/双侧）
钽棒组	50±5	10/20	15/5/10
保守组	50±7	7/23	15/5/10
t值	1.321	1.589	1.935
P值	0.189	0.132	0.798

表2 保守组和钽棒组Harris评分比较（±s）

组别	例数	治疗前	12个月随访	末次随访	F值	P值
保守组	27	59±9	55±10^a	50±8^ab	43.563	0.001
钽棒组	20	58±7	86±5^a	81±7^ab	2563.841	<0.001
F值	?	1.952	1570.658	2031.521	?	?
P值	?	0.175	<0.001	<0.001	?	?

表2 保守组和钽棒组Harris评分比较（±s）

组别	例数	治疗前	12个月随访	末次随访	F值	P值
保守组	27	59±9	55±10^a	50±8^ab	43.563	0.001
钽棒组	20	58±7	86±5^a	81±7^ab	2563.841	<0.001
F值	?	1.952	1570.658	2031.521	?	?
P值	?	0.175	<0.001	<0.001	?	?

图3~6 男性，52岁，双侧FicatⅡ期患者。图3治疗前；图4钽棒植入后12个月，X线示双侧钽棒位置良好，双侧股骨头轮廓光滑；图5钽棒植入后15个月，X线示双侧钽棒位置良好，右侧股骨头轮廓光滑，左侧股骨头部分塌陷；图6左侧THA术后6个月，X线示假体位置良好，右侧钽棒位置良好，股骨头外形正常

图7 保守组和钽棒组生存曲线

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Clinical comparative study of porous coated tantalum rod system in the early nontraumatic osteonecrosis of the femoral head

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Clinical comparative study of porous coated tantalum rod system in the early nontraumatic osteonecrosis of the femoral head