钽棒置入治疗股骨头坏死的疗效分析及预后模型建立  

Therapeutic effect of porous tantalum implantation for osteonecrosis of the femoral head and construction of a prognostic model

作　　者：毛子木 尹崑[1] 王宇泽[1] 李鹏翠[1] 郭丽[1] 卫小春[1] 

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2016年第47期7043-7050,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:多孔钽棒置入作为一种较新的保髋治疗方式,其临床疗效报道褒贬不一。目的:分析2种多孔钽棒置入治疗早中期股骨头坏死的生存数据,确定影响手术成败的独立预后因素。方法:纳入34例ARCOⅠ至Ⅲ期股骨头坏死患者,其中25例31髋进行髓芯减压钽棒置入治疗(单纯钽棒组),9例10髋进行髓芯减压钽棒置入联合同种异体骨植骨治疗(联合组),治疗后随访观察Harris评分与髋累计生存率;采用Cox多因素回归分析出现终点事件的预后因素。结果与结论:(1)单纯钽棒组随访(32.9±16.8)个月,联合组随访(25.3±12.4)个月;(2)末次随访时,两组Harris评分均高于治疗前[单纯钽棒组:(78.52±18.37),(56.97±13.04)分;联合组:(63.30±17.42),(47.90±4.75),P<0.05],单纯钽棒组Harris评分高于联合组(P<0.05);单纯钽棒组髋累计生存率为(50.4±15.8)%,联合组髋累计生存率为(24.0±18.8)%,两组间累计生存率比较差异有显著性意义(P=0.014);(3)Cox多因素回归分析显示,激素使用史、合并其他慢性系统性疾病、是否出现不良反应为转归至出现终点事件的独立预后因素;(4)结果表明,单纯多孔钽棒置入是ARCOⅠ、Ⅱ、Ⅲ期股骨头坏死的有效治疗手段,可改善髋关节功能、延长髋生存期。BACKGROUND：Porous tantalum implantation is a novel treatment method for osteonecrosis of the femoral head （ONFH）, but its therapeutic effect is under discussion. OBJECTIVE：To analyze the survival data of two kinds of porous tantalum implants for early-and mid-stage ONFH, and to determine the independent prognostic factors. METHODS：Thirty-four cases of ARCO stages I-III ONFH were enrol ed, and 25 patients （31 hips） were treated with porous tantalum implantation （simple group）, and the other 9 patients （10 hips） treated with porous tantalum implantation combined with bone al ograft （combination group）. Afterwards, the Harris scores and total survival rate of hips were recorded;the prognostic factors were analyzed by Cox regression. RESULTS AND CONCLUSION：The mean fol ow-up time in the simple and combination groups was （32.9 ±16.8） and （25.3±12.4） months respectively. The Harris scores at the last fol ow-up in the two groups were both higher than those before surgery, and moreover, the scores were higher in the simple group than the combination group （P〈0.05）. The total survival rate of hips significantly differed between groups （P=0.014）. Cox regression showed that the history of hormone, accompanied with other chronic diseases, and adverse reactions made effects on the prognosis. These results suggest that porous tantalum implantation is an effective treatment method for ARCO stages I-III ONFH, and it can improve the functional recovery and survival rate of the hips.

关 键 词：生物材料 骨生物材料 钽棒 股骨头坏死 因素分析 随机森林 累计生存率 

分 类 号：R318[医药卫生—生物医学工程]