摘要
背景:多孔钽棒植入联合髓芯减压治疗早期非创伤性股骨头坏死具有较好的临床效果,但治疗后仍有股骨头塌陷病例的报道,其发生率为2%-56%。目的:探讨多孔钽棒植入治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死后股骨头塌陷情况及其影响因素。方法:回顾性分析2014年5月至2018年4月石家庄市第一医院收治的ARCOⅠ-Ⅱ期非创伤性股骨头坏死患者的病历资料,77例患者均接受多孔钽棒植入治疗,其中男58例,女19例,年龄22-58岁,术后随访观察股骨头塌陷情况。记录患者性别、年龄、股骨头坏死病因、侧别、坏死区位置、范围、ARCO分期、钽棒植入位置(钽棒顶端与坏死中心距离、钽棒与股骨头颈交界区两侧骨皮质距离比值)等临床及手术资料,对临床及手术资料进行单因素分析,采用二元多因素Logistic回归分析筛选出多孔钽棒治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死后塌陷的独立影响因素。研究获得石家庄第一医院伦理委员会批准(批准号:201403011)。结果与结论:①77例患者术后获得3-60个月的随访,其中股骨头塌陷23例,无塌陷54例;②单因素分析显示,塌陷组与无塌陷组性别、年龄、病变侧别、ARCO分期、钽棒顶端与股骨头颈交界区两侧骨皮质距离比值差异无显著性意义(P>0.05),两组股骨头坏死病因、坏死范围、坏死位置分布及钽棒顶端与坏死中心位置距离间差异有显著性意义(P<0.05);③二元多因素Logisitic回归分析显示,激素性股骨头坏死、坏死区范围、坏死区位置为C1型和钽棒顶端距坏死中心距离是影响多孔钽棒治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死后塌陷的独立影响因素[OR=7.977,95%CI(1.031,61.708),P=0.047;OR=7.248,95%CI(1.563,34.548),P=0.012;OR=16.028,95%CI(1.074,239.267),P=0.044;OR=2.310,95%CI(1.388,3.845),P=0.001];④结果表明,多孔钽棒植入治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死术后短期临床效果较好,激素性股骨头坏死、坏死范围、坏死位置及钽棒顶端距坏死中心距离是多孔钽棒治疗ARCOⅠ-Ⅱ期非创伤性股骨头坏死后塌陷的独立影响因素。
BACKGROUND:Porous tantalum rod implantation combined with core decompression in the treatment of early non-traumatic necrosis of the femoral head has a good effect,but there are still reports of femoral head collapse after treatment with an incidence of 2%-56%.OBJECTIVE:To explore the collapse status and influencing factors of porous tantalum rod after treatment of association research circulation osseous(ARCO)stage I-II non-traumatic osteonecrosis of the femoral head.METHODS:The medical record data of 77 patients with non-traumatic necrosis of the femoral head in ARCO stage I-II,who were enrolled in First Hospital of Shijiazhuang City from May 2014 to April 2018 and treated with porous tantalum rod,were retrospectively analyzed.There were 58 males and 19 females,aged 22-58 years.The collapse of femoral head was observed during follow-up after operation.The clinical and surgical data of the patients were recorded,such as sex,age,etiology,side,location and scale of necrosis area,ARCO stage,implantation position of tantalum rod(the distance between the top of tantalum rod and the center of necrosis,the distance ratio between tantalum rod and the cortex on both sides of the border area of femoral head and neck).The clinical and surgical data were analyzed by univariate analysis.Binary multivariate logistic regression analysis was used to screen out the independent influencing factors of the collapse after the treatment of ARCO stage I-II non-traumatic necrosis of the femoral head with porous tantalum rod.This study was approved by the Ethics Committee of First Hospital of Shijiazhuang City(approval No.201403011).RESULTS AND CONCLUSION:(1)Seventy-seven patients were followed up for 3-60 months,including 23 cases of femoral head collapse and 54 cases of no collapse.(2)The results of univariate analysis showed that there was no significant difference in sex,age,lesion side,ARCO stage,and the distance ratio between tantalum rod and the cortex on both sides of the border area of femoral head and neck between collapse group and non-collapse group(P>0.05).There were significant differences in etiology,location and scale of necrosis area,and the distance between the top of tantalum rod and the center of necrosis between the two groups(P<0.05).(3)The results of binary multivariate logistic regression analysis showed that steroid induced necrosis of femoral head,necrosis area located in the load-bearing area,C1 type of necrosis area location and the distance between the top of tantalum rod and necrotic center were the independent factors of collapse after treatment of ARCO I-II non-traumatic necrosis of femoral head with porous tantalum rod[OR=7.977,95%CI(1.031,61.708),P=0.047;OR=7.248,95%CI(1.563,34.548),P=0.012;OR=16.028,95%CI(1.074,239.267),P=0.044;OR=2.310,95%CI(1.388,3.845),P=0.001].(4)Reuslts suggest that the short-term clinical effect of porous tantalum rod was good in the treatment of non-taumatic necrosis of femoral head in ARCO I-II stage.Steroid induced necrosis of femoral head,necrosis area,location of necrosis and the distance from the top of tantalum rod to the necrosis center were the influencing factors of collapse after the treatment of non-traumatic necrosis of femoral head in ARCO I-II stage.
作者
苏敬阳
张耀杰
曹斌
郝学伟
李晓
韩永台
Su Jingyang;Zhang Yaojie;Cao Bin;Hao Xuewei;Li Xiao;Han Yongtai(Department of Orthopedics,First Hospital of Shijiazhuang City,Shijiazhuang 050000,Hebei Province,China;Third Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第15期2400-2404,共5页
Chinese Journal of Tissue Engineering Research
基金
河北省卫计委指导性计划(20170970),项目负责人:苏敬阳。
关键词
骨
植入物
钽
钽棒
股骨头坏死
股骨头塌陷
因素分析
bone
implant
tantalum
tantalum rod
necrosis of femoral head
collapse of femoral head
factor analysis
