中华骨与关节外科杂志
中華骨與關節外科雜誌
중화골여관절외과잡지
Chinese Journal Bone and Joint Surgery
2015年
5期
396-402
,共7页
汪亮%刘耀升%刘蜀彬%王磊%曹云岑%苏秀云%周诗国
汪亮%劉耀升%劉蜀彬%王磊%曹雲岑%囌秀雲%週詩國
왕량%류요승%류촉빈%왕뢰%조운잠%소수운%주시국
关节成形术,置换,髋%股骨头坏死%钽%因素分析,统计学
關節成形術,置換,髖%股骨頭壞死%鐽%因素分析,統計學
관절성형술,치환,관%고골두배사%단%인소분석,통계학
Arthroplasty,Replacement,Hip%Femur Head Necrosis%Tantalum%Factor Analysis,Statistical
背景：多孔钽棒植入已成为治疗早中期股骨头坏死（ANFH）保存关节的主要方法之一，但术后临床疗效仍存在较大争议，同时一些相关因素也会影响术后疗效。<br> 目的：探讨多孔钽棒植入治疗早中期ANFH的中期生存数据，并确定转归至全髋关节置换术（THA）的独立预后因素。方法：将2009年4月至2011年7月进行的前瞻性、连续性接受钽棒植入治疗的SteinbergⅠ、Ⅱ期ANFH患者42例（52髋）作为多孔钽棒组；将2007年4月至2009年3月进行的回顾性、连续性髓芯减压打压植入人工骨填充颗粒的Stein-bergⅠ、Ⅱ期ANFH患者36例（49髋）作为复合人工骨材料组。记录人口统计学和基线特征包括年龄、性别、病因、单双侧发病、相关慢性系统性疾病、Steinberg分期、术前Harris评分、伴有股骨头骨髓水肿和骨坏死病灶大小等。记录术中失血量、输血情况，记录术后住院时间、髋关节Harris评分和累计生存率。<br> 结果：术前两组人口统计学和基线特征差异无统计学意义。多孔钽棒组患者平均随访（48.2±4.5）个月（38~62个月），复合人工骨材料组患者平均随访（71.6±5.1）个月（67~85个月）。末次随访时，多孔钽棒组Harris评分为（84.18±2.35）分，复合人工骨材料组Harris评分为（76.34±2.67）分，两组患者髋关节Harris评分较术前均有显著提高，差异有统计学意义（P＜0.0001）。术后髋关节Harris评分多孔钽棒组提高（26.2±2.5）分，复合人工骨材料组提高（17.3±3.6）分，与复合人工骨材料组比较，多孔钽棒组提高幅度较大，差异有统计学意义（F=4.22，P=0.0426）。Kaplan-Meier生存曲线比较显示，随访62个月时，多孔钽棒组髋关节累计生存率为74.1%±9.5%，显著高于复合人工骨材料组髋关节的49.9%±10.8%（χ2=3.912，P=0.048）。Cox比例风险模型显示，股骨头骨髓水肿（RR=7.090, P=0.003）、皮质激素使用（RR=3.599, P=0.007）、多孔钽棒植入（RR=0.306, P=0.012）为ANFH转归至THA的独立预后因素。<br> 结论：髓芯减压结合多孔钽棒植入治疗SteinbergⅠ、Ⅱ期ANFH可显著缓解髋关节疼痛、改善髋关节功能和提高髋关节生存率。对于未使用皮质激素，尤其是未伴有股骨头骨髓水肿的早中期ANFH，髓芯减压结合多孔钽棒植入可使髋关节获得更高的生存率，并能延迟或阻止THA的转归。
揹景：多孔鐽棒植入已成為治療早中期股骨頭壞死（ANFH）保存關節的主要方法之一，但術後臨床療效仍存在較大爭議，同時一些相關因素也會影響術後療效。<br> 目的：探討多孔鐽棒植入治療早中期ANFH的中期生存數據，併確定轉歸至全髖關節置換術（THA）的獨立預後因素。方法：將2009年4月至2011年7月進行的前瞻性、連續性接受鐽棒植入治療的SteinbergⅠ、Ⅱ期ANFH患者42例（52髖）作為多孔鐽棒組；將2007年4月至2009年3月進行的迴顧性、連續性髓芯減壓打壓植入人工骨填充顆粒的Stein-bergⅠ、Ⅱ期ANFH患者36例（49髖）作為複閤人工骨材料組。記錄人口統計學和基線特徵包括年齡、性彆、病因、單雙側髮病、相關慢性繫統性疾病、Steinberg分期、術前Harris評分、伴有股骨頭骨髓水腫和骨壞死病竈大小等。記錄術中失血量、輸血情況，記錄術後住院時間、髖關節Harris評分和纍計生存率。<br> 結果：術前兩組人口統計學和基線特徵差異無統計學意義。多孔鐽棒組患者平均隨訪（48.2±4.5）箇月（38~62箇月），複閤人工骨材料組患者平均隨訪（71.6±5.1）箇月（67~85箇月）。末次隨訪時，多孔鐽棒組Harris評分為（84.18±2.35）分，複閤人工骨材料組Harris評分為（76.34±2.67）分，兩組患者髖關節Harris評分較術前均有顯著提高，差異有統計學意義（P＜0.0001）。術後髖關節Harris評分多孔鐽棒組提高（26.2±2.5）分，複閤人工骨材料組提高（17.3±3.6）分，與複閤人工骨材料組比較，多孔鐽棒組提高幅度較大，差異有統計學意義（F=4.22，P=0.0426）。Kaplan-Meier生存麯線比較顯示，隨訪62箇月時，多孔鐽棒組髖關節纍計生存率為74.1%±9.5%，顯著高于複閤人工骨材料組髖關節的49.9%±10.8%（χ2=3.912，P=0.048）。Cox比例風險模型顯示，股骨頭骨髓水腫（RR=7.090, P=0.003）、皮質激素使用（RR=3.599, P=0.007）、多孔鐽棒植入（RR=0.306, P=0.012）為ANFH轉歸至THA的獨立預後因素。<br> 結論：髓芯減壓結閤多孔鐽棒植入治療SteinbergⅠ、Ⅱ期ANFH可顯著緩解髖關節疼痛、改善髖關節功能和提高髖關節生存率。對于未使用皮質激素，尤其是未伴有股骨頭骨髓水腫的早中期ANFH，髓芯減壓結閤多孔鐽棒植入可使髖關節穫得更高的生存率，併能延遲或阻止THA的轉歸。
배경：다공단봉식입이성위치료조중기고골두배사（ANFH）보존관절적주요방법지일，단술후림상료효잉존재교대쟁의，동시일사상관인소야회영향술후료효。<br> 목적：탐토다공단봉식입치료조중기ANFH적중기생존수거，병학정전귀지전관관절치환술（THA）적독립예후인소。방법：장2009년4월지2011년7월진행적전첨성、련속성접수단봉식입치료적SteinbergⅠ、Ⅱ기ANFH환자42례（52관）작위다공단봉조；장2007년4월지2009년3월진행적회고성、련속성수심감압타압식입인공골전충과립적Stein-bergⅠ、Ⅱ기ANFH환자36례（49관）작위복합인공골재료조。기록인구통계학화기선특정포괄년령、성별、병인、단쌍측발병、상관만성계통성질병、Steinberg분기、술전Harris평분、반유고골두골수수종화골배사병조대소등。기록술중실혈량、수혈정황，기록술후주원시간、관관절Harris평분화루계생존솔。<br> 결과：술전량조인구통계학화기선특정차이무통계학의의。다공단봉조환자평균수방（48.2±4.5）개월（38~62개월），복합인공골재료조환자평균수방（71.6±5.1）개월（67~85개월）。말차수방시，다공단봉조Harris평분위（84.18±2.35）분，복합인공골재료조Harris평분위（76.34±2.67）분，량조환자관관절Harris평분교술전균유현저제고，차이유통계학의의（P＜0.0001）。술후관관절Harris평분다공단봉조제고（26.2±2.5）분，복합인공골재료조제고（17.3±3.6）분，여복합인공골재료조비교，다공단봉조제고폭도교대，차이유통계학의의（F=4.22，P=0.0426）。Kaplan-Meier생존곡선비교현시，수방62개월시，다공단봉조관관절루계생존솔위74.1%±9.5%，현저고우복합인공골재료조관관절적49.9%±10.8%（χ2=3.912，P=0.048）。Cox비례풍험모형현시，고골두골수수종（RR=7.090, P=0.003）、피질격소사용（RR=3.599, P=0.007）、다공단봉식입（RR=0.306, P=0.012）위ANFH전귀지THA적독립예후인소。<br> 결론：수심감압결합다공단봉식입치료SteinbergⅠ、Ⅱ기ANFH가현저완해관관절동통、개선관관절공능화제고관관절생존솔。대우미사용피질격소，우기시미반유고골두골수수종적조중기ANFH，수심감압결합다공단봉식입가사관관절획득경고적생존솔，병능연지혹조지THA적전귀。
Background:The implantation of a porous tantalum rob is one of the main methods for the treatment of moderate avascular necrosis of femoral head (ANFH), but the outcomes have been debated for years. And several correlation factors will also af-fect clinical outcomes. <br> Objective:To investigate the mid-term survival of porous tantalum rob implants in patients with moderate ANFH, and to identify independent prognostic factors for conversion to total hip arthroplasty (THA). <br> Methods:Forty-two consecutive patients (52 hips) with Steinberg stageⅠandⅡosteonecrosis obtained from a prospective study were enrolled in experiment group. They underwent porous tantalum rob implantation between April 2009 and July 2011. Thirty-six consecutive patients (49 hips) with Steinberg stageⅠandⅡosteonecrosis obtained from a retrospective study were enrolled in control group. They were treated by core decompression and artificial bone grafting between April 2007 and March 2009. Demographics and baseline characteristics including age, sex, etiology, bilateral disease, associated chronic systemic disease, Steinberg stage, Harris hip score, accompanied with bone marrow edema of femoral head, and os-teonecrotic lesion size were recorded. Intraoperative blood loss, transfusion, postoperative hospital stay, Harris hip scores and hip survival rates were also recorded. <br> Results:There were no significant differences in the demographic or baseline characteristics between groups. The average duration of follow-up was (48.2 ± 4.5) months (range, 38-62 months) in the experiment group and was (71.6 ± 5.1) months (range, 67-85 months) in the control group. At the final follow-up, Harris hip scores were 84.18 ± 2.35 in the experiment group and were 76.34±2.67 in the control group, which were significantly higher than preoperative ones in both groups (P<0.0001). The amplification of Harris score in the experiment group was significantly greater than that in the control group (26.2 ± 2.5 vs 17.3 ± 3.6, F=4.22, P=0.0426). A comparison of Kaplan-Meier curves showed a significantly higher survival rate for hips with implantation of the porous tantalum rob than those with artificial bone grafting (74.1%± 9.5%vs 49.9%± 10.8%,χ2=3.912, P=0.048) at 62 months after surgery. The Cox proportional-hazard model revealed that bone marrow ede-ma (RR=7.090, P=0.003), corticosteroid intake (RR=3.599, P=0.007) and implantation of tantalum rob (RR=0.306, P=0.012) were the independent prognostic factors related to conversion into THA. <br> Conclusions: Core decompression combined with implantation of porous tantalum rod can significantly relieve pain, im-prove function of hip joint, increase hip survival rate in patients with Steinberg stageⅠandⅡANFH. For the patients with-out corticosteroid intake, especially for those without bone marrow edema, implantation of porous tantalum rod shows a high survival rate and a delay or prevention of conversion into THA.
