股骨头坏死钽棒植入后中期随访失败原因分析  

Retrospective analysis of clinically failed implants following porous tantalum implantation for femoral head osteonecrosis

作　　者：马金辉[1] 孙伟[1] 郭万首[1] 李子荣[1] 王佰亮[1] 王卫国[1] 史振才[1] 岳德波[1] 刘朝晖[1] 

机构地区：[1]中日友好医院骨关节外科,北京100029

出　　处：《中华关节外科杂志（电子版）》2017年第4期4-9,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81372013)

摘　　要：目的评估钽金属棒治疗股骨头缺血性坏死后的生存率并评价其临床效果和影像学结果,分析其转归至全髋关节置换术(THA)的原因。方法回顾性分析2008年6月至2013年12月于中日友好医院骨坏死与关节保留重建中心因股骨头缺血性坏死行钽金属棒联合自体骨植入的101例患者(117髋)进行评价。纳入标准:非创伤性股骨头缺血性坏死。排除标准:存在手术禁忌、先前接受过任何其他类型治疗的病例、髋关节继发骨关节炎病例。根据国际骨循环协会(ARCO)分期,Ⅱ期49髋,Ⅲ期68髋;根据中日友好医院(CJFH)分型,L1型15髋,L2型59髋,L3型40髋,C型3髋。应用SPSS 19.0软件进行统计学分析。采用t检验或单因素方差分析进行手术前后及术后各组间髋关节Harris评分比较。采用分类变量的2检验或Fisher精确检验对影响影像学进展及转归至THA的因素进行分析。对性别、年龄、体重指数、有无骨髓水肿、单双侧、病因、ARCO分期、CJFH分型等因素使用Cox比例风险模型进行多变量分析以确定造成转归至THA和影像学进展的独立危险因素。结果最终90例患者(104髋)获得随访,平均随访时间为(46±21)个月,平均年龄为(39±8)岁。终末随访时,Harris评分自术前(76±13)分降至术后(69±15)分,组间差异有统计学意义(t=3.939,P<0.01),最终49髋转归至THA,根据多因素Cox风险比列模型分析年龄,CJFH分型和ARCO分期是全髋关节置换和影像学进展的独立危险因素。结论钽金属棒治疗股骨头缺血性坏死的临床效果欠佳,影响其临床结局的因素包括年龄(>40岁),CJFH分型(L3型),ARCO分期(Ⅲ期),应严格把握该手术适应证。Objective To evaluate the clinical results and radiographic outcomes of porous tantalum implant in the treatment of osteonecrosis of femoral head（ ONFH）. Methods A total of 101 ONFH patients（ 117 consecutive hips） treated with porous tantalum implant combined with bone grafting between June 2008 and December 2013 in China-Japan friendship hospital were evaluated. The inclusion criteria： diagnosis of non-traumatic ONFH. The exclusion criteria： surgical contraindication, having received any other type of surgical treatment,and secondary arthritis. According to the classification system of Association Research Circulation Osseous（ ARCO）,49 hips were in stageⅡ,and 68 hips were in stageⅢ; as to China-Japan friendship hospital（ CJFH） classification,15 hips were type L1,59 hips were type L2,40 hips were type L3,three hips were type C. The data were analyzed using SPSS 19. 0 statistical software. The t test or one-way analysis of variance was used to compare pre-and postoperative Harris hip score（ HHS） among different groups. A chi-square test or Fisher exact text was performed to compare the rate of radiological progression and conversion to total hip arthroplasty（ THA） among different groups. The Cox proportional hazards model were used to analyze the independent factors associated with conversion to THA and radiological failure. Results Ninety patients（ 104 hips） were available for follow-up with a mean time of（ 46 ± 21） months. The mean age was（ 39 ± 8） years. At the last follow-up or before converting to THA,the mean postoperative HHS score for all the hips（ 69 ± 15） was less than the mean preoperative HHS score（ 76 ± 13）（ t = 3. 939,P 0. 01）. Overall 49 hips converted to THA. According to analysis of Cox risky model,age,CJFH type and ARCO stage were independent risk factors for conversion to THA and failure of radiography. Conclusion Porous tantalum implantation is not a viable option for the treatment of ONFH,and the clinical failure is associated with ag

关 键 词：股骨头坏死 钽 假体和植入物 结果评价(卫生保健) 治疗失败 

分 类 号：R687.4[医药卫生—骨科学]