2024 年第 3 期 第 19 卷

早期股骨头坏死采用改良髓芯减压植骨术结合多孔钽棒材料治疗的可行性分析

Feasibility analysis of early femoral head necrosis treated with improved core decompression and bone grafting surgery combined with porous tantalum rod material

作者：党海峰樊俊俊杨超郝治龙薛宝宝石磊

英文作者：Dang Haifeng Fan Junjun Yang Chao Hao Zhilong Xue Baobao Shi Lei

单位：空军军医大学第一附属医院骨科，西安710032

英文单位：Department of Orthopedics the First Affiliated Hospital of Air Force Military Medical University Xi′an 710032 China

关键词：股骨头坏死；多孔钽棒；保髋手术；改良髓芯减压植骨术；临床价值

英文关键词：Femoralheadnecrosis;Poroustantalumrod;Hippreservationsurgery;Improvedcoredecompressionandbonegraftingsurgery;Clinicalvalue

• 摘要：

• 目的 探讨对早期股骨头坏死（ONFH）患者采用改良髓芯减压植骨术结合多孔钽棒材料治疗的可行性。方法 选取2021年1月至2022年10月空军军医大学第一附属医院收治的72例（72髋）早期ONFH患者作为研究对象。采用随机数字表法分为对照组和观察组，各36例。对照组给予常规髓芯减压植骨术治疗，观察组给予改良髓芯减压植骨术结合多孔钽棒材料治疗。对比2组围手术期指标，术前及术后6个月疼痛视觉模拟量表（VAS）评分、Fugl-Meyer平衡量表（FMA）评分、Harris髋关节功能评分，髋关节活动度，临床疗效，以及术后并发症发生情况。结果 观察组手术时间、术中出血量、骨折愈合时间短于/少于对照组［（51±17）min比（62±15）min、（103±26）ml比（135±36）ml、（11.5±1.6）周比（13.2±2.6）周］，差异均有统计学意义（均P<0.05）。术后6个月观察组VAS评分低于对照组，FMA评分、Harris髋关节功能评分均高于对照组，差异均有统计学意义（均P＜0.001）。术后6个月2组髋关节外旋、内旋、外展、内收、后伸、前屈角度均大于术前，且观察组均大于对照组，差异均有统计学意义（均P＜0.05）。观察组临床疗效优良率高于对照组［97.2%（35/36）比80.6%（29/36）］，差异有统计学意义（χ2=5.063，P=0.024）。观察组和对照组并发症总发生率差异无统计学意义（P>0.05）。结论 改良髓芯减压植骨术结合多孔钽棒材料治疗早期ONFH可行。该方法安全性高且操作简便，能够有效减轻早期ONFH患者髋膝部疼痛，改善髋关节活动度与平衡能力。

• Objective To explore the feasibility of early femoral head necrosis(ONFH) treated with improved core decompression and bone grafting surgery combined with porous tantalum rod material. Methods Totally 72 patients (72 hips) with early ONFH admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2021 to October 2022 were selected as the study subjects. They were divided into control group and observation group by the random number table method, with 36 cases in each group. The control group received conventional core decompression and bone grafting surgery treatment, while the observation group received improved core decompression and bone grafting surgery combined with porous tantalum rod material. The perioperative indicators, preoperative and postoperative visual analogue scale(VAS) score, Fugl-Meyer balance scale (FMA) score, Harris hip joint function score, hip joint range of motion, clinical efficacy, and postoperative complications of the two groups were compared. Results The surgical time, intraoperative bleeding, and fracture healing time in the observation group were shorter/less than those in the control group［(51±17)min vs (62±15)min, (103±26)ml vs (135±36)ml, (11.5±1.6)weeks vs (13.2±2.6)weeks］, and the differences were statistically significant (all P<0.05). After 6 months of surgery, the VAS score of the observation group was lower than that of the control group, while the FMA score and Harris hip joint function score were higher than those of the control group, with statistically significant differences(all P<0.001). At 6 months after surgery, the hip joint angles of external rotation, internal rotation, abduction, adduction, extension, and flexion in both groups were greater than those before surgery, and the observation group was greater than the control group, with statistically significant differences(all P<0.05). The clinical efficacy excellent and good rate of the observation group was higher than that of the control group［97.2%(35/36) vs 80.6%(29/36)］, and the difference was statistically significant (χ2=5.063, P=0.024). There was no statistically significant difference in the total incidence of complications between the observation group and the control group(P>0.05). Conclusions  The combination of improved core decompression and bone grafting surgery combined with porous tantalum rod material for the treatment of early ONFH is feasible. The method is safe and easy to operate, and can effectively alleviate hip and knee pain in early ONFH patients, and improve hip joint mobility and balance ability.