髓芯减压植骨与多孔钽棒植入修复非创伤性股骨头坏死

背景：髓芯减压植骨是临床上常用的一种方法,随着对股骨头生物力学研究的深入,多孔钽棒技术也越来越多的用于保髋手术,但这两种术式在临床上疗效比较报道较少。 目的：比较髓芯减压植骨与多孔钽棒植入治疗非创伤性股骨头缺血性坏死的临床疗效。 方法：选择36例(45髋)成人股骨头缺血坏死患者,其中15例(19髋)采用髓芯减压植骨治疗,21例(26髋)采用髓芯减压多孔钽棒植入治疗。 结果及结论：植入治疗均成功,随访3~12个月,两组手术时间、出血量、住院天数比较差异均无显著性意义,治疗后Harris评分较治疗前均有明显提高(P < 0.05),治疗后12个月Harris评分,多孔钽棒植入高于植骨治疗(P < 0.05),差异显著性意义。髓芯减压与多孔钽棒植入对早期成人股骨头坏死髋关节功能改善优于髓芯减压植骨,预防了关节软骨的逐渐塌陷。     

早期股骨头缺血性坏死治疗：髓芯减压并钽棒优于并植骨

背景：单纯髓芯减压并植骨治疗早期股骨头缺血性坏死对软骨下骨支撑不够,增加了骨折及塌陷的风险。钽棒的置入不仅可以提供很好的生物学支撑,也会增加坏死区域的再血管化,从而达到修复股骨头坏死的作用。目的：比较髓芯减压并植骨、髓芯减压并钽棒置入治疗早期股骨头缺血性坏死的临床效果。方法：纳入髓芯减压并植骨治疗ARCOⅠ/Ⅱ期股骨头缺血性坏死患者24例28髋,髓芯减压并钽棒置入治疗ARCOⅠ/Ⅱ期股骨头缺血性坏死患者25例29髋。随访24个月,观察治疗前后Harris评分变化及临床疗效。结果与结论：所有患者均获得随访。治疗后6个月,髓芯减压并植骨组患者Harris评分较治疗前平均提高了4.93分;髓芯减压并钽棒置入组患者Harris评分较治疗前平均提高了6.89分,差异有显著性意义(P < 0.05)。治疗后12个月,2组患者Harris评分均有治疗前显著提高,髓芯减压并植骨组患者Harris评分低于髓芯减压并钽棒置入组(P < 0.05)。髓芯减压并钽棒置入组总的治疗优良率为83%,优于髓芯减压并植骨组的75%。治疗后24个月髓芯减压并钽棒置入组X射线评分显著高于髓芯减压并植骨组(P < 0.05)。提示与髓芯减压并植骨相比,髓芯减压并钽棒置入能够更有效地防止股骨头塌陷,改善关节功能及延缓股骨头坏死进程。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

早期股骨头坏死治疗:髓芯股方肌骨块植入优于骨浆植入

背景:单纯髓芯减治疗早期股骨头缺血性坏死对软骨下骨支撑不够,增加了骨折及塌陷的风险。股方肌骨块的植入不仅可以提供很好的生物学支撑,也会增加坏死区域的再血管化,从而达到修复股骨头坏死的作用。目的:比较髓芯减压股方肌骨块植入和髓芯减压骨浆植入治疗早期股骨头缺血性坏死的早期临床效果。方法:选取2009年1月至2012年1月在郑州大学第一附属医院骨科进行治疗的早期股骨头坏死患者83例92髋,按治疗方法分为髓芯减压股方肌骨块植入组及髓芯减压骨浆植入组。其中髓芯减压股方肌骨块植入组37例43髋于坏死区注射自体骨转移及骨诱导活性材料,髓芯减压骨浆植入组患者46例49髋则注入骨粉。结果与结论:治疗后1年,2组患者Harris评分均比治疗前显著提高(P0.05),髓芯减压骨浆植入组患者Harris评分低于髓芯减压股方肌骨块植入组(P0.05)。治疗后3年髓芯减压股方肌骨块植入组患者X射线评分显著高于髓芯减压骨浆植入组(P0.05)。提示与髓芯减压骨浆植入相比,髓芯减压股方肌骨块植入能够更有效地防止股骨头塌陷,改善关节功能及延缓股骨头坏死进程。     

有限元分析髓芯减压并同种异体植骨治疗股骨头缺血性坏死的生物力学改变

目的:分析髓芯减压并同种异体植骨治疗早期股骨头缺血性坏死的临床应用。方法:选取收治的1例早期股骨头缺血坏死男性患者,入院后术前对患侧股骨头行多层螺旋CT扫描,然后将CT扫描的图片资料导入专业的有限元分析软件,建立股骨头缺血坏死的有限元模型,在有限元模型上模拟进行髓芯钻孔减压术,隧道植入骨块到软骨下骨约0~6 mm处,自体松质骨夯实。双足站立位为股骨头的模拟受力体位,髋关节的负荷条件为:外展肌合力M、髂胫束力T以及髋关节接触力J分别为1 060、1 721、1 621 N,选取90°、120°以及150°的坏死角度,分别计算未处理过的股骨头坏死模型的塌陷值、行单纯髓芯减压以及行髓芯减压加植骨时的塌陷值。结果:股骨头的正常骨质杨氏模量高于坏死骨的杨氏模量,正常骨质的横向变形系数低于坏死骨。行股骨头髓芯钻孔减压术后,股骨头的塌陷值显著增加,而减压隧道植入同种异体骨后,其塌陷值显著减低,但高于正常的股骨头。同时,由于股骨头坏死角度的增加,其塌陷值也明显增加。结论:髓芯钻孔减压并同种异体植骨术能有效增进坏死区的骨质修复,加强减压通道所致股骨头支撑结构的改变,防止股骨头关节面的塌陷。     

记忆合金网球支架治疗成人股骨头缺血性坏死的生物力学研究

目的：对比研究单纯髓芯减压、髓芯减压＋松质骨移植、髓芯减压＋松质骨移植＋记忆合金网球植入治疗成人股骨头缺血性坏死的生物力学行为。方法：取新鲜人股骨头0根，模拟髓芯减压松质骨移植治疗股骨头缺血性坏死的方法做成髓芯减压后的状态，用MTS生物力学实验机测得每例标本在单纯减压、减压值及植骨＋网球三种状态下的力学刚度，对其结果进行统计学分析。结果：单纯髓芯减压组和髓芯减压＋松质骨移植组统计学无明显差异，髓芯减压＋松质骨移植＋记忆合金网球植入优于前两种状态。结论：镍钛记忆合金网球植入增加了股骨头负重区软骨下骨的机械支撑，降低局部应力有利于股骨头坏死的修复与重建。     

纳米羟基磷灰石/聚酰胺66骨支撑材料与钽棒置入修复早期股骨头坏死:近期效果比较

背景:有研究将纳米羟基磷灰石复合聚酰胺66材料用在早期股骨头坏死的治疗中取得了很好的疗效,可显著降低疼痛、延缓股骨头塌陷。目的:比较髓芯减压植骨合并纳米羟基磷灰石/聚酰胺66复合生物支架的置入、髓芯减压植骨合并钽棒置入治疗早期股骨头缺血性坏死的临床效果。方法:将60例早期股骨头坏死患者随机分入观察组和对照组,观察组采用髓芯减压植骨合并纳米羟基磷灰石/聚酰胺66生物支架置入治疗,对照组采用髓芯减压植骨合并钽棒置入治疗。比较两组手术时间、术后引流量、住院天数、住院费用、术后疼痛发生情况;随访12个月,比较两组Harris评分、影像学疗效评判情况和综合疗效。结果与结论:观察组术后引流量、住院时间、住院费用低于对照组(P0.05),两组手术时间、术后发生疼痛例数比较差异无显著性意义(P0.05)。Harris评分中,观察组仅行走辅助评分明显优于对照组(P0.05),两组影像学疗效评判情况、综合疗效评判比较差异无显著性意义(P0.05)。结果表明对于早期股骨头坏死患者,髓芯减压植骨合并钽棒置入和髓芯减压植骨合并纳米羟基磷灰石/聚酰胺66置入在改善患者临床症状方面疗效相当。     

髓芯减压植骨结合骼金骨笼置入治疗早期非创伤性股骨头坏死的短期疗效观察

目的探讨髓芯减压植骨结合骼金骨笼置入治疗早期非创伤性股骨头坏死的手术方法及短期疗效。方法因非创伤性股骨头坏死的患者60例,将其随机分为研究组和对照组各30例,研究组采用髓芯扩大减压自体髂骨打压植骨结合骼金骨笼植入支撑治疗,对照组采用传统髓芯减压术治疗。对患者髋关节功能状况、塌陷情况进行比较分析。结果根据髋关节Harris评分,研究组优良率明显高于对照组研究组(0.05);研究组仅出现1例塌陷,对照组出现8例,两组比较差异显著(0.05)。结论髓芯减压植骨结合骼金骨笼置入治疗早期非创伤性股骨头坏死可明显改善髋关节功能,防止股骨头塌陷,疗效满意。     

股骨头髓芯减压为基础治疗早期股骨头坏死

背景：髓芯减压治疗早期股骨头坏死效果较好,而且髓芯减压方法简单易行,即使远期治疗效果不理想也不影响行人工全髋关节置换。 目的：探讨以股骨头髓芯减压为基础的3种方法治疗早期股骨头坏死的临床疗效。 方法：根据国际骨循环研究学会(Association Research Circulation Osseous,ARCO)股骨头坏死分期标准,纳入股骨头坏死患者46例(61髋),Ⅰ期21例(29髋),Ⅱ期25例(32髋)。其中15例(23髋)行单纯髓芯减压治疗,18例(25髋)行髓芯减压联合自体骨髓单个核细胞移植治疗,13例(13髋)行髓芯减压联合多孔钽棒置入治疗。 结果与结论：全部患者均获12个月随访,3组患者末次随访时髋关节Harris评分均高于术前(P < 0.01),末次随访时联合细胞移植组和联合多孔钽棒组Harris评分高于单纯髓芯减压组(P < 0.01),而联合细胞移植组和联合多孔钽棒组比较差异无显著性意义(P > 0.05)。髋关节X射线检查：单纯髓芯减压组2例(3髋)发展为塌陷、联合细胞移植组1例(1髋)发展为塌陷,联合多孔钽棒组2例(2髋)出现塌陷。结果可见以股骨头髓芯减压为基础的3种方法治疗早期股骨头坏死均有效,其中髓芯减压联合自体骨髓单个核细胞移植或多孔钽棒置入近期疗效优于单纯髓芯减压治疗。     

不同结构骨块植入股骨头负重区缺损的力学性能比较

目的股骨头缺血坏死早中期手术中,为防止股骨头的进一步塌陷,常需要植骨填充坏死区。本文研究不同结构植入物填充股骨头负重区缺损后对股骨头力学性能的影响。方法选取人正常股骨近段4例,在股骨头负重区沿压力骨小梁方向制造直径20mm,深30mm的骨缺损,并在缺损区内植入三种不同结构的植入物。Ⅰ组为取自异体股骨头负重区骨块;Ⅱ组为取自异体股骨髁负重区骨块;Ⅲ组为松质骨粒打压植骨。模拟单腿站立相加载,记录股骨头颈结合部的应变分布。结果直径20mm深30mm骨缺损的股骨近段与正常相比,头颈结合部上方拉应变平均增加93.0%,下方压应变平均增加203.4%。植入不同结构的植入物后,Ⅰ组头颈结合部上方应变较正常平均增加6.6%,下方应变平均增加67.6%;Ⅱ组上方应变较正常平均增加33.7%,下方应变平均增加136.9%;Ⅲ组上方应变平均增加150.4%,下方应变平均增加206.1%。结论股骨头负重区的缺损会改变头颈结合部应力分布,其中结合部下方和上方出现应力的集中。植入与缺损区的骨小梁结构相似的异体股骨头骨块后,股骨头下方和上方头颈结合部的应力集中得到缓解,其植入效果优于骨小梁结构不同的股骨髁骨块;松质骨粒打压植骨不能改变股骨头头颈结合部的应变分布。     

髓芯减压联合同种异体骨打压植骨治疗早期股骨头坏死的疗效观察

目的 探讨髓芯减压联合同种异体骨打压植骨治疗早期股骨头坏死的临床疗效。方法 采用随机数字表法将2016年1月~2017年6月于我院诊治的早期股骨头坏死患者40例分为两组,各20例。对照组采用多孔钽棒植入治疗,观察组行髓芯减压联合同种异体骨打压植骨治疗,比较两组患者治疗前后Harris髋关节评分及临床疗效。结果 治疗前两组患者Harris评分差异无统计学意义（P＞0.05）,治疗后观察组Harris评分优于对照组[（82.56±8.42）分 vs （74.53±7.31）分],差异有统计学意义（P＜0.05）;观察组治疗总有效率高于对照组,组间差异有统计学意义（P＜0.05）。结论 早期股骨头坏死患者选择髓芯减压+同种异体骨打压植骨治疗效果显著,可充分改善患者髋关节功能,促使患者尽早康复,值得临床上广泛应用。     

钽金属棒置入修复股骨头坏死的三维有限元分析

BACKGROUND: Core decompression and tantalum rod implantation after core decompression are common methods to repair early and middle stages of necrosis of femoral head, can effectively control and even reverse the progress of necrosis of the femoral head. Comparison of mechanical support and curative effect of femoral head after operation deserves further investigation. OBJECTIVE: To explore the effect of core decompression on mechanical pulp femoral head support by using the finite element analysis and the advantages of tantalum implant treatment in the repair of avascular necrosis of the femoral head.  METHODS: The right femur of healthy adults was chosen as the research object, and CT scanning was conducted to get the images of cross-sections. The images were then inputted into computer to get contour of femur and rebuild three-dimensional model. Distal end of femur was completely fixed, the angle of the top of femoral head and the femoral shaft was 25°, and 570 N pressure on the femoral head was applied according to the three-dimensional space distribution of femur force under physiological state. Three-dimensional finite element models were calculated to get the collapse values in different necrotic areas of the femoral head before and after different repair methods. RESULTS AND CONCLUSION: After core decompression, collapse values were apparently increased, especially in the weight-bearing area. With increased range of necrosis, collapse values also increased. After core decompression, collapse values decreased obviously after porous tantalum rod implantation. Although core decompression could remove dead bone, decompression itself further reduced the mechanical properties of the femoral head and changed the original femoral head support. On the basis of core decompression, porous tantalum rod provided safe and effective mechanical support for femoral head and subchondral bone plate, could effectively prevent collapse and provide conditions for the restoration of bone tissue.      

多孔钽棒改善股骨颈骨折术后股骨头缺血性坏死患者的髋关节功能：随机对照临床试验方案

BACKGROUND:After femoral neck fracture, avascular necrosis of the femoral head occurs because of insufficient blood supply to the femoral head, resulting in increased difficulty in treatment, and greatly influencing the recovery of hip joint function. Core decompression and bone grafting is a common treatment method of avascular necrosis of the femoral head. A porous tantalum rod is a bone trabecula-like metal implant that is used to support weight-bearing area of necrotic bone, prevent further collapse of the necrotic area, and thereby exhibits favorable effects in the early treatment of avascular necrosis of the femoral head. Few randomized controlled studies are reported on porous tantalum rod implantation for treatment of avascular necrosis of the femoral head after femoral neck fracture surgery. OBJECTIVE: To investigate whether porous tantalum rod implantation can improve the hip joint function of patients with avascular necrosis of the femoral head subjected to femoral neck fracture surgery. METHODS: This is a prospective, single-center, randomized, controlled, open trial, which will be performed in the Department of Orthopedic Trauma, Qinghai University Affiliated Hospital, China. A total of 100 patients with avascular necrosis of the femoral head subjected to femoral neck fracture surgery will be randomly assigned to undergo core decompression and porous tantalum rod implantation (experimental group, n=50) or only core decompression (control group, n=50). All patients will be followed up for 1 year. Primary outcome measure is the percentage of patients whose hip joint function is graded as excellent as per Harris scores 12 months after surgery in total patient number in each group, which will be used to evaluate the recovery of hip joint function. Secondary outcome measures include (1) the percentage of patients with excellent hip joint function 1 and 6 months after surgery in total patient number in each group; (2) Visual Analogue Scale spine score prior to and 1, 6 and 12 months after surgery, which will be used to evaluate the severity of pain; (3) the percentage of patients presenting with femoral head collapse, prosthesis loosening and peri-prosthesis infection 6 and 12 months after surgery, which will be used to evaluate the biocompatibility of biomaterial with host; and (4) incidence of complications 6 and 12 months after surgery, which will be used to evaluate the safety of porous tantalum rod implantation. This study protocol has been approved by the Medical Ethics Committee of Qinghai University Affiliated Hospital of China (approval number: QHY1016B) and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding trial procedure and treatment will be obtained from each patient.  DISCUSSION: This study is powered to validate the biocompatibility and therapeutic effects of porous tantalum rods in the treatment of avascular necrosis of the femoral head after femoral neck fracture surgery, which hopes to provide a novel persuasive surgical treatment method for this disease.     

Effect of porosity on the fluid flow characteristics and mechanical properties of tantalum scaffolds

In many cases of traumatic bone injury, bone grafting is required. The primary source of graft material is either autograft or allograft. The use of both material sources are well established, however, both suffer limitations. In response, many grafting alternatives are being explored. This article specifically focuses on a porous tantalum metal grafting material (Trabecular Metaltrade mark) marketed by Zimmer. Twenty-one cylindrical scaffolds were manufactured (66% to 88% porous) and tested for porosity, intrinsic permeability, tangent elastic modulus, and for yield stress and strain behavior. Scaffold microstructural geometries were also measured. Tantalum scaffold intrinsic permeability ranged from 2.1 x 10(-10) to 4.8 x 10(-10) m(2) and tangent elastic modulus ranged from 373 MPa to 2.2 GPa. Both intrinsic permeability and tangent elastic modulus closely matched porosity-matched cancellous bone specimens from a variety of species and anatomic locations. Scaffold yield stress ranged from 4 to 12.7 MPa and was comparable to bovine and human cancellous bone. Yield strain was unaffected by scaffold porosity (average = 0.010 mm/mm). Understanding these structure-function relationships will help complete the basic physical characterization of this new material and will aid in the development of realistic mathematical models, ultimately enhancing future implant designs utilizing this material.     

股骨头缺血性坏死多层螺旋CT三维构筑及介入治疗的临床意义

目的:探讨采用多层螺旋CT对股骨头缺血性坏死进行三维立体构筑的技术方法及介入治疗的临床价值.方法:使用Siemens Somatom Definition 64层螺旋CT对31例股骨头缺血性坏死患者共36髋进行薄层扫描,利用Inspace软件和NeuroDSA软件进行影像重组和三维立体构筑,并在X、Y和Z轴上旋转,观察股骨头的解剖形态.对I期坏死患者采用单纯经股骨头供血动脉灌注扩张血管及溶栓药物进行介入治疗;对II期及股骨头外形完整的III期患者首先采用介入治疗,然后经环钻剜出坏死骨植入混合自体骨髓间充质干细胞的自体松质骨.结果:容积重组图像显示早期缺血坏死的股骨头解剖形态基本正常,股骨头表面可见凹凸不平.股骨头坏死区的体积I期(8髋)为(1218.97±449.93)mm3,II期(22髋)为(3671.19±1316.83)mm3,股骨头完整的III期(6髋)为(7874.18±2381.22)mm3.根据HHS评分,疗效优23髋(63.89%),良10髋(27.78%),可3髋(8.33%),差0髋.结论:多层螺旋CT三维重组技术能够立体构筑股骨头的解剖形态,并在不同层面上对坏死区的大小进行测量,对股骨头缺血性坏死患者治疗方法的选择具有重要的临床指导意义.     

股骨头表面置换对正常股骨头组织学的影响

背景：拟通过建立动物模型探讨目前的髋关节表面置换的假体设计是否达到成熟、是否能引起股骨头坏死。 目的：观察健康新西兰大白兔股骨头表面置换后的组织形态变化。 方法：60只健康大白兔行左股骨头表面置换,右侧为正常对照侧。分3,6,9,12周共4次分批处死取股骨头标本行大体、光镜、扫描电镜观察。 结果与结论：股骨头表面置换后,股骨头骨质仅在与骨水泥接触界面(骨-水泥界面)有小范围的骨细胞坏死和肉芽组织增生纤维化、以及骨吸收;与金属假体接触的界面(骨-假体界面)亦有轻度小范围骨细胞坏死和肉芽组织增生纤维化,但无骨吸收表现;在远离骨水泥和假体的股骨头中心部位既无骨坏死表现,亦无骨吸收表现,组织表现与正常未手术骨质相同。结果可见股骨头表面置换不会引起正常股骨头的坏死,股骨头坏死与术式及假体本身无因果关系,在一定程度上肯定了表面置换治疗髋关节疾患的安全性和优越性。