CAJ | 학술논문

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60～100 min（平均70 min）、术中出血量200～400 mL（平均280 mL）。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±4）分，较术前的（62±3）分明显提高（t=6.505，P=0.000）。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。
목적탐토단봉식입연합대혈관체가골판전이치료중청년조기고골두배사적림상료효。방법회고성분석2007년10월지2012년1월중산대학부속강문의원채용단봉식입연합대혈관체가골판전이치료적11례（15관）중청년조기고골두배사환자적림상자료，기록수술시간、술중출혈량，관찰내치단봉송동、단렬급증상개선정황，말차수방시진행관관절Harris평분화영상학검사。결과11례환자수방12～60개월（평균24개월）。수술시간60～100 min（평균70 min）、술중출혈량200～400 mL（평균280 mL）。수방기간내치단봉미견송동、단렬，미출현단봉배척반응。환관동통감감경혹소실，말차수방시Harris평분위（85±4）분，교술전적（62±3）분명현제고（t=6.505，P=0.000）。영상학검사미견고골두탑함，식골구역미출현골배사추세。결론단봉식입연합대혈관체가골판전이수술가개선혈공，제공족구적역학지지，유효방지고골두진일보탑함，림상공능개선효과교이상，시치료중청년조기고골두배사적유효방법。
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 (15 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.