Veillette Christian J H, Mehdian Hossein, Schemitsch Emil H, McKee Michael D
J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:48-55. doi: 10.2106/JBJS.F.00538.
For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas vascularized fibular grafting requires an extensive surgical procedure with high donor-site morbidity and prolonged rehabilitation. The adjunctive use of a porous tantalum implant offers the advantages of core decompression, structural support, minimally invasive surgery, and no donor-site morbidity. The purpose of this study was to assess the survivorship and to evaluate the clinical results and radiographic outcomes of hips in which osteonecrosis of the femoral head was treated with core decompression and a porous tantalum implant.
We evaluated fifty-four patients (sixty consecutive hips) in whom osteonecrosis of the femoral head was treated with core decompression and insertion of a porous tantalum implant. Fifty-two patients (fifty-eight hips) were available for follow-up at a mean of twenty-four months. All patients were sixty-five years of age or younger (mean age, thirty-five years). According to the classification system of Steinberg et al., one hip (2%) had stage-I disease, forty-nine hips (84%) had stage-II disease, and eight hips (14%) had stage-III disease. Outcome measures that were used included a limb-specific score (Harris hip score), radiographic outcome measures, and survivorship analysis with revision to total hip arthroplasty as the end point.
Overall, nine hips (15.5%) were converted to total hip arthroplasty, including six with stage-II disease and three with stage-III disease. The overall survival rates were 91.8% (95% confidence interval, 87.8% to 95.8%) at twelve months, 81.7% (95% confidence interval, 75.8% to 87.6%) at twenty-four months, and 68.1% (95% confidence interval, 54.7% to 81.5%) at forty-eight months. The absence of chronic systemic diseases resulted in a survival rate of 92% at forty-eight months (95% confidence interval, 87.4% to 96.4%).
Treatment of early stage osteonecrosis of the femoral head with core decompression and a porous tantalum implant can be accomplished with a minimally invasive technique and no donor-site morbidity. The early clinical results show encouraging survival rates in patients who do not have chronic systemic disease, especially in association with early stage disease.
Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
对于股骨头坏死的早期阶段，保留股骨头是主要目标；然而，关于如何最好地实现这一目标尚未达成共识。单纯的髓芯减压缺乏结构支撑，结果不一致，而带血管腓骨移植需要广泛的手术操作，供区并发症发生率高且康复时间长。使用多孔钽植入物作为辅助手段具有髓芯减压、结构支撑、微创手术以及无供区并发症等优点。本研究的目的是评估采用髓芯减压和多孔钽植入物治疗股骨头坏死的髋关节的生存率，并评估其临床结果和影像学结果。
我们评估了54例（60髋）接受髓芯减压和多孔钽植入物治疗的股骨头坏死患者。52例患者（58髋）可进行平均24个月的随访。所有患者年龄均在65岁及以下（平均年龄35岁）。根据斯坦伯格等人的分类系统，1髋（2%）为I期疾病，49髋（84%）为II期疾病，8髋（14%）为III期疾病。使用的结果指标包括肢体特异性评分（Harris髋关节评分）、影像学结果指标以及以翻修为全髋关节置换术作为终点的生存率分析。
总体而言，9髋（15.5%）接受了全髋关节置换术，其中6髋为II期疾病，3髋为III期疾病。12个月时的总体生存率为91.8%（95%置信区间，87.8%至95.8%），24个月时为81.7%（95%置信区间，75.8%至87.6%），48个月时为68.1%（95%置信区间，54.7%至81.5%）。无慢性全身性疾病的患者48个月时的生存率为92%（95%置信区间，87.4%至96.4%）。
采用髓芯减压和多孔钽植入物治疗早期股骨头坏死可通过微创手术完成，且无供区并发症。早期临床结果显示，对于无慢性全身性疾病的患者，尤其是与早期疾病相关的患者，生存率令人鼓舞。
治疗性IV级。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
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