CAJ | 학술논문

目的探讨单纯钽棒与钽棒联合自体骨移植治疗早期股骨头坏死的临床效果. 方法回顾分析24例股骨头缺血性坏死的治疗经验,其中一侧行髋关节置换,一侧行股骨头髓芯减压、自体骨移植、钽棒植入的双侧股骨头坏死患者共12例,男9例,女3例.年龄28～49岁,平均35.7岁.Ficat分期:换髋侧为Ⅲ～Ⅳ期;髓芯减压、自体骨移植、钽棒植入侧为Ⅱ期.同一时间段,根据随机化原则,选择12例股骨头坏死单侧行髓芯减压、钽棒植入患者作为对照组.男8例,女4例.年龄25 ～ 46岁,平均33.2岁.Ficat分期均为Ⅱ期. 结果术后随访24 ～ 62个月,平均(42.5±6.7)个月.钽棒组Harris评分(82.6±5.3)分,与术前(平均65.3±6.3)相比,差异有统计学意义(P＜0.05);影像学进展与术前相比差异有统计学意义(P＜0.05),以全髋人工关节置换术为终点,2例转为髋关节置换.钽棒联合自体骨移植组Harris评分(92.2±1.0)分,与术前(65.9±6.9)分比较,差异有统计学意义(P＜0.05);影像学进展与术前相比差异有统计学意义(P＜0.05),以全髋人工关节置换术为终点,髋关节生存率为100％(12/12).组间比较提示钽棒联合骨移植组,患髋临床功能优于钽棒组(P＜0.05),影像学进展至Ⅲ期以上两组之间无明显差异(P＞0.05),但髋关节生存率的情况存在明显差异(P＜0.05). 结论自体骨植入加钽棒置入技术比单纯钽棒植入,可以更好的缓解髋疼痛,延缓行人工髋关节置换的时间.
목적 탐토단순단봉여단봉연합자체골이식치료조기고골두배사적림상효과. 방법 회고분석24례고골두결혈성배사적치료경험,기중일측행관관절치환,일측행고골두수심감압、자체골이식、단봉식입적쌍측고골두배사환자공12례,남9례,녀3례.년령28～49세,평균35.7세.Ficat분기:환관측위Ⅲ～Ⅳ기;수심감압、자체골이식、단봉식입측위Ⅱ기.동일시간단,근거수궤화원칙,선택12례고골두배사단측행수심감압、단봉식입환자작위대조조.남8례,녀4례.년령25 ～ 46세,평균33.2세.Ficat분기균위Ⅱ기. 결과 술후수방24 ～ 62개월,평균(42.5±6.7)개월.단봉조Harris평분(82.6±5.3)분,여술전(평균65.3±6.3)상비,차이유통계학의의(P＜0.05);영상학진전여술전상비차이유통계학의의(P＜0.05),이전관인공관절치환술위종점,2례전위관관절치환.단봉연합자체골이식조Harris평분(92.2±1.0)분,여술전(65.9±6.9)분비교,차이유통계학의의(P＜0.05);영상학진전여술전상비차이유통계학의의(P＜0.05),이전관인공관절치환술위종점,관관절생존솔위100％(12/12).조간비교제시단봉연합골이식조,환관림상공능우우단봉조(P＜0.05),영상학진전지Ⅲ기이상량조지간무명현차이(P＞0.05),단관관절생존솔적정황존재명현차이(P＜0.05). 결론 자체골식입가단봉치입기술비단순단봉식입,가이경호적완해관동통,연완행인공관관절치환적시간.
Objective To discuss the efficacy of tantalum rod implantation combined with bone transplantation in the treatment of early stage osteonecrosis of the femoral head.Methods Twenty-four male patients were re cruited.Twelve patients were allocated to the tantalum rod and bone implantation group.The mean age was 35.7 years.Twelve patients were allocated to the tantalum rod implantation group.The mean age was 33.2 years.All patients with stage Ⅱ osteonecrosis.Results All patients were followed up with an average of 42.5 ± 6.7 months.The final evaluation was made according to the last follow-up data.In the tantalum rod implantation group,the average score of pre-operation and post-operation were 65.3±6.3,82.6 ± 5.3 respectively with a statistic difference (P ＜ 0.05).Two of patients underwent total hip replacement before the end of this study,significant difference was observed in the aspect of radiographic progression (P ＜ 0.05).In the tantalum rod implantation combined with bone marrow stem cell transplantation group,the average score was 92.2 ± 1.0 with a statistic difference (P ＜ 0.05).There was no one of patients underwent total hip replacement before the end of this study.Significant difference was observed in the aspect of radiographic progression (P ＜ 0.05).Between the two groups,a significant difference was observed in clin ical symptoms in favor of the tantalum rod implantation combined with bone transplantation group(P ＜ 0.05).No significant difference was observed in the aspect of radiographic progression (P ＞ 0.05).Significant difference was observed in the aspect of survivorship of the femoral head(P ＜ 0.05).Conclusion Tantalum rod implantation combined with bone transplantation improves clinical symptoms and delay total hip arthoplasty than tantalum rod implantation.