Liu Yaosheng, Su Xiuyun, Zhou Shiguo, Wang Lei, Wang Cheng, Liu Shubin
Department of Orthopaedics, The 307 Hospital, PLA Beijing 100071, People's Republic of China.
Statistics Room, Capital Medical University Affiliated Beijing Friendship Hospital Beijing 100050, People's Republic of China.
Int J Clin Exp Med. 2015 Feb 15;8(2):1918-30. eCollection 2015.
Tantalum rod implant following core decompression is reported to be effective in early stage of osteonecrosis of the femoral head (ONFH). The purpose of this study was to assess the survivorship and prognostic factors for radiographic progression and conversion to total hip arthroplasty (THA) after treatment with a modified tantalum implant technology. 59 consecutive hips (45 patients) in whom ONFH was treated with core decompression, impaction bone grafting of 2 mm-composite bone filling material, and insertion of a porous tantalum implant. 57 hips (44 patients, mean age 43 years, range 21 to 70 years) with Steinberg Stage I-IVA ONFH were available for follow-up at a mean of 44.8 months (rang, 11 to 62 months). Outcome measures included HHS (Harris Hip Score), radiographic outcome, and survivorship analysis with reversion to THA. Radiographic progression occurred in 17 hips (17/57, 29.82%). 11 hips (11/57, 19.30%) were converted to THA. The overall survival rate was 72.49% at 60 months post-operatively. After logistic regression analysis, corticosteroid use and bone marrow edema were found to be predictors of radiographic progression. The Cox proportional-hazard model revealed that bone marrow edema was an independent prognostic factor for conversion to THA. This modified technology may make patients avoid the use of corticosteroid, especially those without bone marrow edema, and obtains encouraging survival rates and a delay in or prevention of THA.
据报道，在股骨头坏死（ONFH）早期，进行髓芯减压后植入钽棒是有效的。本研究的目的是评估采用改良钽植入技术治疗后，股骨头坏死的生存率以及影像学进展和转换为全髋关节置换术（THA）的预后因素。连续纳入59例髋关节（45例患者），这些患者的股骨头坏死采用髓芯减压、2mm复合骨填充材料打压植骨及多孔钽植入物植入进行治疗。57例髋关节（44例患者，平均年龄43岁，范围21至70岁），Steinberg分期为I-IVA期的股骨头坏死患者可供随访，平均随访时间为44.8个月（范围11至62个月）。观察指标包括HHS（Harris髋关节评分）、影像学结果以及转换为全髋关节置换术的生存分析。17例髋关节（17/57，29.82%）出现影像学进展。11例髋关节（11/57，19.30%）转换为全髋关节置换术。术后60个月时总体生存率为72.49%。经逻辑回归分析，发现使用皮质类固醇和骨髓水肿是影像学进展的预测因素。Cox比例风险模型显示，骨髓水肿是转换为全髋关节置换术的独立预后因素。这种改良技术可能使患者避免使用皮质类固醇，尤其是那些没有骨髓水肿的患者，并获得令人鼓舞的生存率，以及延迟或预防全髋关节置换术。
