中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (14): 2133-2139.doi: 10.3969/j.issn.2095-4344.2017.14.001

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials •    下一篇

钽棒置入与腓骨支撑修复早期股骨头坏死

杨  开1，曾  平2，欧志学3，赖崇荣1，黄海滨2，刘明伟2，黄肖华2，何  伟4   

  1. 1广西中医药大学，广西壮族自治区南宁市  530001；2广西中医药大学第一附属医院骨三科，广西壮族自治区南宁市  530023；3广西中医药大学附属瑞康医院骨科，广西壮族自治区南宁市  530011；4广州中医药大学第一附属医院关节三骨科，广东省广州市  510000
  • 收稿日期:2017-03-19 出版日期:2017-05-18 发布日期:2017-06-10
  • 通讯作者: 曾平，博士，教授，广西中医药大学第一附属医院骨三科，广西壮族自治区南宁市 530023
  • 作者简介:杨开，男，1988年生，湖南省长沙市人，广西中医药大学在读硕士，主要从事中医药防治股骨头坏死的相关研究。
  • 基金资助:

    国家自然科学基金项目(81360551)；广西科学研究与技术开发计划项目(桂科攻1140003B-57)；广西医疗卫生重点科研课题(重2011053)

Tantalum rod implantation versus fibular fixation in the treatment of osteonecrosis of the femoral head at early stage

Yang Kai1, Zeng Ping2, Ou Zhi-xue3, Lai Chong-rong1, Huang Hai-bin2, Liu Ming-wei2, Huang Xiao-hua2, He Wei4   

  1. 1 Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China; 2 Third Department of Orthopedics, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China; 3 Department of Orthopedics, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China; 4 Department of Joint Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
  • Received:2017-03-19 Online:2017-05-18 Published:2017-06-10
  • Contact: Zeng Ping, M.D., Professor, Third Department of Orthopedics, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China
  • About author:Yang Kai, Studying for master’s degree, Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81360551; the Science Research and Technology Development Project of Guangxi Province, No. 1140003B-57; the Medical and Health Research Project of Guangxi Province, No. 2011053

PDF

217

被引次数

1

摘要：

文章快速阅读：

 

文题释义：
腓骨支撑术：是基于髓芯减压的基础上联合植骨，结合股骨颈骨折内固定术演变而来。其原理是经减压孔道，植入腓骨起支撑作用，重建或维持股骨头外形，为坏死区的修复创造一个相对有利的环境。
多孔钽金属植入物：是以碳纤维支架为骨架，外喷涂钽金属涂层构成，碳纤维支架为多重十二面体的网状结构，其孔隙率可高达98%，明显高于其他生物固定材料如钴、铬、钛等30%-50%的孔隙率，遍布支架的所有孔隙均为相同或相近的六角形结构。碳支架表面的钽层厚40-60 μm。


背景：腓骨支撑以及钽棒置入是治疗早期股骨头坏死常见的方法，可有效延缓甚至逆转股骨头坏死进展，但二者术后股骨头力学支撑与疗效对比需要进一步探讨。
目的：比较腓骨支撑、钽棒置入修复早期股骨头坏死的临床效果。
方法：ARCOⅠ期、Ⅱ期股骨头坏死患者共58例81髋，按治疗方案分为2组，其中腓骨支撑组30例41髋采用腓骨支撑术治疗，钽棒置入组28例40髋采用钽棒置入术治疗。2组术后均获得2年以上随访，比较治疗前、后髋关节Harris评分，分别以股骨头塌陷和股骨头塌陷> 4 mm为观察截点，比较不同ARCO分期2组股骨头生存率。
结果与结论：①2组术后Harris评分均较术前明显提高，差异有显著性意义(P < 0.05)；②以术后股骨头塌陷为观察截点的Kaplan-Meier生存曲线比较显示，髋关节总生存率腓骨支撑组为83%，钽棒置入组为65%；经log-rank(Mantel-Cox)检验，2组ⅡC期髋关节生存率差异有显著性意义(P=0.043 1)；③以术后股骨头塌陷> 4 mm为股骨头生存终点Kaplan-Meier 生存曲线比较显示，髋关节总生存率腓骨支撑组为95%，钽棒置入组为83%；经log-rank(Mantel-Cox)检验，2组ⅡC期髋关节生存率差异有显著性意义(P=0.041 8)；④综上，腓骨支撑术、钽棒置入术治疗早期股骨头坏死均可有效改善髋关节功能；ARCOⅡC期患者腓骨支撑治疗的髋关节生存率优于钽棒置入。

ORCID: 0000-0002-2377-8988(杨开)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 生物材料, 骨生物材料, 股骨头坏死, 早期, 腓骨支撑术, 钽棒置入术, 股骨头塌陷, 生存率, 疗效比较, 国家自然科学基金

Abstract:

BACKGROUND: Fibular fixation and tantalum rod implantation are two commonly used methods for the treatment of early osteonecrosis of the femoral head (ONFH), both of which can effectively delay or even reverse the progress of ONFH. However, further comparative evaluation on their mechanical properties and therapeutic efficacy is required.
OBJECTIVE: To compare the clinical efficacy of fibular fixation and tantalum rod implantation on ONFH at early stage.
METHODS: Fifty-eight patients (81 hips) suffered from ONFH with ARCO stage 1 and stage 2, and underwent fibular fixation (30 cases, 41 hips) or tantalum rod implantation (28 cases, 40 hips). Postoperatively, both groups were followed up for over 2 years. The Harris scores of the hip were compared between two groups before and after treatment. With femoral head collapse and the collapse distance > 4 mm as observation points, the survival rate of the femoral head was compared between two groups.
RESULTS AND CONCLUSION: The postoperative Harris scores of the two groups were significantly improved than before (P < 0.05). With the appearance of femoral head collapse as the observation point, the Kaplan-Meier survival curve showed that the overall survival rate of the hip was 83% in the fibular fixation group and 65% in the tantalum rod implantation group. After examined by log-rank (Mantel-Cox), there was a significant difference in the survival rate of the hip at Stage IIC between two groups (P=0.043 1). With > 4 mm collapse as the observation point, the Kaplan-Meier survival curve showed that overall survival rate of the hip was 95% in the fibular fixation group and 83% in the tantalum rod implantation group. After examined by log-rank (Mantel-Cox), there was a significant difference in the survival rate of the hip at Stage IIC between two groups (P=0.041 8). To conclude, both fibular fixation and tantalum rods implantation applied to ONFH at early stage can effectively improve the hip function, and the survival rate of the hip at ARCO Stage IIC is better in patients undergoing fibular fixation than tantalum rod implantation.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Fibula, Femur Head Necrosis, Tissue Engineering

中图分类号: