髓芯减压联合钽棒植入治疗早期股骨头坏死疗效观察与分析

发布时间：2018-06-11 20:01

本文选题：股骨头坏死 + 多孔钽棒　；参考：《山东大学》2017年硕士论文

【摘要】：背景和目的:股骨头坏死(Osteonecrosis of femoral head,ONFH)也被称作股骨头缺血性坏死(avascularnecrosis,AVN),是骨科的常见疾病。疾病常呈进展性发展,80%以上的病人最终会进展为股骨头塌陷[1,2]。疾病晚期严重影响患者髋关节功能,因此对于疾病的早期治疗便显得尤为重要,疾病早期常选用多种保髋治疗方案。钽棒植入便是临床上常用的保髋治疗方案之一,钽棒是由钽金属制成的多孔蜂窝状立体结构,具有与人体骨组织相近的抗压强度和弹性模量,其硬度也适用于传导生理负重,并且具有良好的生物相容性和安全性,因此可被用作髓芯减压后的植入物治疗早期股骨头坏死。近年来针对钽棒植入治疗早期股骨头坏死的疗效存在较大争议,因此本研究旨在探究髓芯减压联合多孔钽棒植入治疗早期股骨头坏死的临床疗效,评估其术后效果。分析失败病例并探寻影响钽棒植入术后效果的因素,借以指导钽棒植入的适应征的选择。方法:选取自2009年3月至2017年2月就诊于山东大学齐鲁医院骨科行髓芯减压联合多孔钽棒植入术患者,共随访成功16例患者(17髋),其中男性患者14例(15髋),女性患者2例(2髋),平均年龄为36.41 ±7.88岁(20～54),股骨头坏死分期选用Steinberg分期[3],其中Ⅰ期5髋,Ⅱ期12髋。按病因分类:酒精型7髋,激素型4髋,特发型6髋。分析资料来源于患者住院临床病例资料,统计信息包括病人术前基本信息(性别、年龄、身高、体重、病程、症状、体征、影像学资料如髋关节MRI及X线),患者手术记录中的相关信息(包括手术时间、术中出血量、术中植入钽棒的规格等),术后恢复情况(如术后伤口恢复情况、功能锻炼情况及有无术后并发症的出现),术前术后髋关节Harris评分,以行全髋关节置换作为终点事件,对于已行THA手术患者选取其THA术前评分作为末次随访评分参与统计分析。结果:1.平均随访时间36.88 ±28.81个月(2～90),术前平均Harris评分65.06±21.80分(22～96),术后切口均一期愈合,未出现伤口感染、不愈合、伤口破裂出血、深部血管栓塞、血管神经损伤、钽棒松动及断裂等术后并发症。2.随访期间有4例患者股骨头呈进展性塌陷,其中3例已行全髋关节置换术,1例暂行保守治疗。末次随访Harris评分平均82.94± 19.66分(36～100)。以Harris评分90～100分为优,80～89分为良,70～79分为可,70分为差。末次随访Harris评分中:11例为优,2例为良,可0例,4例为差,末次随访Harris评分优良率为76.47%。术前术后Harris评分差别有统计学意义,P0.05(P=0.044)。3.分析手术效果的影响因素,如病因、患者年龄、术前评分、随访时长(月)、体重指数(BMI)、术前发病时间(月)、术前Steinberg分期、术中植入钽棒规格、手术时间(min)、术中出血(ml)、术后住院天数等,结果提示髓芯减压联合钽棒植入术对酒精型股骨头坏死的手术效果优于激素型及特发型;术前评分、Steinberg分期以及术前发病天数对术后Harris评分的影响具有统计学差异。术前Harris评分和术前Steinberg分期与术后效果呈负相关,术前发病时间对术后效果的影响也具有显著差异,其系数为正,表明术前发病时长与术后效果呈正相关。结论:随访自2009年3月至2017年2月就诊于齐鲁医院骨科行髓芯减压联合多孔钽棒植入术患者16例患者(17髋),对比术前术后髋关节Harris评分,对于股骨头坏死进展已行THA手术患者选取其THA术前评分作为末次随访评分参与统计分析,分析对比术前术后效果,探究手术效果影响因素。结果显示末次随访优良率为76.47%,对比国内外相关文献,本组患者钽棒植入术具有较好的术后优良率,考虑原因为本组患者术前Steinberg分期均为Ⅰ期及Ⅱ期,无Ⅲ期及Ⅲ期以上患者,就诊于我院的Ⅲ期患者常选用肌骨瓣植入等手术方式,因此术后效果较好。髓芯减压联合钽棒植入术具有手术操作简单、平均手术时间短、术中失血少的优势,是治疗早期股骨头坏死一种低创伤的、有效的治疗方法。手术患者术后的髋关节Harris评分较术前有明显提高且差距具有统计学意义,P0.05。表明钽棒植入术可以改善早期股骨头坏死患者的症状,尤其是可以明显缓解疼痛症状,可以恢复髋关节功能,延缓疾病的进展,推迟或避免THA的转归,是早期股骨头坏死的一种切实可行的治疗方法,尤其适用于酒精型股骨头坏死患者及Steinberg分期Ⅰ期和Ⅱ期的患者,不建议应用于Steinberg分期或ARCO分期Ⅲ期或Ⅲ期以上患者。
[Abstract]:Background and purpose: Osteonecrosis of femoral head (ONFH) is also known as avascularnecrosis (AVN). It is a common disease in the Department of orthopedics. The disease is often progressing, and more than 80% of the patients will eventually develop the hip joint function in the late stage of the femoral head collapse [1,2]. disease. Early treatment of the disease is particularly important. A variety of hip conservation treatments are often used early in the disease. Tantalum rod implantation is one of the most commonly used hips in clinical. The tantalum rod is a porous honeycomb structure made of tantalum metal, which has the compression strength and modulus of elasticity similar to that of human bone tissue. The hardness of tantalum rod is also suitable for conduction physiology. Weight negative, good biocompatibility and safety, and therefore can be used as an implant after core decompression for the treatment of early femoral head necrosis. In recent years, the effect of tantalum rod implantation in the treatment of early femoral head necrosis has been controversial. Therefore, the aim of this study is to explore the combination of core reduction and porous tantalum implantation for the treatment of early femoral head injury. The clinical effect of death was evaluated and the results were evaluated. The failure cases were analyzed and the factors affecting the effect of tantalum rod implantation were explored to guide the selection of the indications of tantalum rod implantation. Methods: from March 2009 to February 2017, the patients who visited the Department of orthopedics, Qilu Hospital of Shandong University were treated with core decompression combined with porous tantalum rod implantation, and 1 successful patients were followed up. 6 cases (17 hips), of which 14 cases (15 hips) and 2 cases (2 hips) in female patients, the average age was 36.41 + 7.88 years (20~54). Steinberg staging of femoral head necrosis was selected by [3], including 5 hips and 12 hips of stage II. According to the etiology: alcoholic 7 hip, hormone 4 hip, and specially developed 6 hips. Analysis data were derived from clinical data of patients hospitalized, The statistical information included basic preoperative information (gender, age, height, weight, course of disease, symptoms, signs, imaging data such as MRI and X-ray of the hip), related information in the patient's surgical records (including operation time, intraoperative bleeding, tantalum bars in the operation, etc.), and postoperative recovery (such as postoperative wound recovery, functional exercise) The Harris score of hip joint before and after operation was taken as an end point of total hip arthroplasty. The THA preoperative score was selected as the final follow-up score for the patients who had been operated on THA operation. The results were as follows: the average follow-up time was 36.88 + 28.81 months (2~90), and the average Harris score was 65.06 + 21.8 before the operation. 0 points (22~96), postoperative wound healing, no wound infection, nonunion, rupture and bleeding, deep vascular embolization, vascular nerve injury, tantalum rod loosening and fracture in 4 patients with progressive collapse of femoral head during follow-up period, of which 3 cases had total hip arthroplasty and 1 cases were temporarily conservative. The last follow-up was followed up. The average score of Harris was 82.94 + 19.66 (36~100). The score of Harris was 90~100 good, 80~89 was good, 70~79 was good, and 70 was poor. In the last follow-up Harris score, 11 cases were excellent, 2 was good, 0, 4 were poor, and the fine rate of the last follow-up Harris score was 76.47%. The difference of Harris score before and after operation was statistically significant, P0.05 (P=0.044 .3. analysis of the influencing factors, such as the cause of the operation, the age of the patients, the preoperative score, the long (month), the body mass index (BMI), the preoperation time (month), the preoperative Steinberg staging, the tantalum stick specification, the operation time (min), the intraoperative bleeding (ML), the number of days after the operation, and so on, the results suggested that the core decompression combined with tantalum implantation for alcohol type femur. The effect of osteonecrosis is better than that of hormone type and special type. Preoperative score, Steinberg staging and the number of pre operation days have statistically significant difference in the effect of postoperative Harris score. The preoperative Harris score and preoperative Steinberg staging are negatively correlated with the postoperative effect, and the effect of pre operation time on postoperative effect is also significantly different. The number is positive, indicating a positive correlation between the length of the preoperation and the postoperative effect. Conclusion: from March 2009 to February 2017, 16 patients (17 hips) were treated in the Department of orthopedics of Qilu Hospital of the Qilu Hospital with porous tantalum rod implantation. Compared with the Harris score of the hip joint before and after the operation, the patients with the necrosis of the femoral head had been selected for their THA. The preoperative score was used as the final follow-up score for statistical analysis. The results were analyzed and compared before and after the operation. The results showed that the excellent rate of the last follow-up was 76.47%. Compared with the relevant literature at home and abroad, the group of patients with tantalum rod implantation had good postoperative good rate. The reason for this was the Steinberg staging of the patients in this group. For stage I and stage II, there is no stage III and stage III patients, and the patients in stage III of the hospital are often treated with musculoskeletal flap implantation. Therefore, the effect is better after the operation. The combined operation of core decompression and tantalum rod implantation has the advantages of simple operation, short operation time and less blood loss during the operation, which is a low trauma for the treatment of early femoral head necrosis. Effective treatment. The Harris score of the hip joint after operation is significantly higher than that before operation and the gap is statistically significant. P0.05. shows that tantalum rod implantation can improve the symptoms of early femoral head necrosis, especially to relieve the pain symptoms, restore the hip function, delay the progression of the disease, postpone or avoid the disease. THA free transfer is a practical treatment for early femoral head necrosis, especially for patients with alcoholic femoral head necrosis and Steinberg stage I and stage II, and is not recommended for patients with Steinberg or ARCO stages of stage III or stage III.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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