CAJ | 학술논문

目的：评估改良钽棒技术治疗早中期股骨头坏死术后转归至全髋关节置换的预后因素。方法对自2006年6月至2010年1月解放军第三〇七医院骨科髓芯减压结合改良钽棒技术治疗Steinberg Ⅰ～ⅣA股骨头坏死患者45例（59髋），钽棒植入前股骨头扩大髓芯减压后打压植入5 mm厚的复合人工骨填充材料，术后3个月完全限制负重。结果患者44例（57髋），平均年龄43（21～70）岁，获得随访平均44.8（11～62）个月。终末随访时，Harris评分自术前（59.9±2.8）分提高至术后（77.8±3.0）分（P＜0.001），11髋（19.3％）转归至关节置换术，随访60个月时髋关节生存率为72.5％。多因素Cox风险比例模型显示骨髓水肿是术后转归至全髋关节置换术的独立预后因素（ HR＝10.326；95％CI，1.31～81.54；χ2＝8.617， P＝0.003）。结论改良钽棒植入手术治疗早中期股骨头坏死可获得较高的生存率，伴骨髓水肿的股骨头坏死钽棒植入术后预后较差。
목적：평고개량단봉기술치료조중기고골두배사술후전귀지전관관절치환적예후인소。방법대자2006년6월지2010년1월해방군제삼〇칠의원골과수심감압결합개량단봉기술치료Steinberg Ⅰ～ⅣA고골두배사환자45례（59관），단봉식입전고골두확대수심감압후타압식입5 mm후적복합인공골전충재료，술후3개월완전한제부중。결과환자44례（57관），평균년령43（21～70）세，획득수방평균44.8（11～62）개월。종말수방시，Harris평분자술전（59.9±2.8）분제고지술후（77.8±3.0）분（P＜0.001），11관（19.3％）전귀지관절치환술，수방60개월시관관절생존솔위72.5％。다인소Cox풍험비례모형현시골수수종시술후전귀지전관관절치환술적독립예후인소（ HR＝10.326；95％CI，1.31～81.54；χ2＝8.617， P＝0.003）。결론개량단봉식입수술치료조중기고골두배사가획득교고적생존솔，반골수수종적고골두배사단봉식입술후예후교차。
Objective To assess the survival and prognostic significance of various demographic and radiographic parameters for conversion into total hip arthroplasty after treatment with a modified porous tantalum implant technology for early and intermediate stages of osteonecrosis of the femoral head ( ONFH).Methods This study included 45 patients ( 59 hips ) with Steinberg Stage Ⅰ-ⅣA ONFH undergoing progressively core decompression , impaction bone grafting of 5 mm-composite bone filling material and inserting of a porous tantalum implant.Weight-bearing was forbidden within the first 3 months after implants.Results A total of 57 hips (44 patients) were available during a mean follow-up period of 44.8 (11-62 ) months.Their mean age was 43 ( 21 -70 ) years.The mean Harris hip score significantly improved from 59.93 ±2.80 preoperative to 77.84 ±2.95 at the last follow-up (P<0.001).Overall, 11 hips ( 19.30%) were converted into total hip arthroplasty.The overall survival rate was 72.49% at 60 months postoperatively.The Cox proportional hazard model revealed that bone marrow edema was an independent prognostic factor related with a conversion into total hip arthroplasty.Conclusion Higher survival rates may be obtained from modified tantalum implant technology for early and intermediate stages of ONFH.And prognosis was poor for patients of ONFH with bone marrow edema.