多孔涂层钽金属棒系统治疗成人股骨头缺血性坏死

背景：多孔涂层钽金属棒系统是专一应用于股骨头缺血性坏死的新型内植物系统,其良好的生物力学特性可为塌陷前股骨头提供必要的软骨下骨支撑,同时具有较好的生物相容性,并可采用微创方式置入,有广阔的应用前景。 目的：评价多孔涂层钽金属棒系统治疗成人股骨头缺血性坏死的效果和应用价值。 方法：自2008-05/2010-06对22例成人股骨头缺血性坏死患者施行多孔涂层钽金属棒系统固定治疗。其中男17例,女5例,平均年龄39.5岁。病变分期中Ficat Ⅰ期3例,Ficat Ⅱ期19例。单侧17例,双侧5例。置入前髋关节症状以疼痛和跛行为主,Harris评分平均52.5分。 结果与结论：置入后随访2-25个月。患者切口均一期愈合,无感染、内植物松动等并发症发生。在随访期间内X射线检查未发现明显股骨头塌陷及囊变区扩大等病变进展迹象,患者疼痛、跛行等症状缓解明显。终末随访时Harris评分为85.5分,与置入前相比差异有显著性意义。主观满意度：优17例,良3例,中2例,总体优良率91%。结果可见多孔涂层钽金属棒系统置入治疗Ficat Ⅰ、Ⅱ期成人股骨头缺血性坏死可取得良好的早、中期效果。     

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：     

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。     

多孔钽棒置入治疗股骨头坏死16例

背景：髓心减压及钽棒置入治疗早期股骨头坏死的手术方法,尤其适合于股骨头坏死SteinbergⅠ期和Ⅱ期,既可以解决疼痛又可以防治股骨头的塌陷延缓坏死的进展,是一种值得尝试的新方法。 目的：探讨多孔钽棒置入治疗股骨头坏死的适应症及其临床疗效。 方法：纳入股骨头坏死16例18髋,根据Steinberg分期：Ⅰ期5髋,Ⅱ期12髋,Ⅲ期A 1髋。采用侧方小切口入路,行髓心减压及多孔坦棒置入。置入后6周内禁止负重,6~10周部分负重,逐步过渡至完全负重。采用Harris评分系统评估患者置入后髋关节功能改善情况;置入后24 h、1,3,6,12个月摄正侧位X射线平片,观察股骨头修复情况及有无坏死进展。 结果与结论：16例18髋获得随访,随访时间7~13个月。置入后末次随访进行疗效评估,优：11例12髋,良：4例5髋,可：1例1髋。患者Harris评分由置入前49~83分,平均(65.3±8.6)分,提高至置入后75~97分,平均(88.2±9.3)分,治疗前后比较差异有显著性意义(P < 0.05)。随访摄片髋关节影像学表现稳定,股骨头无坏死进展。提示,多孔钽棒假体置入治疗股骨头坏死疗效确切,尤其是对于SteinbergⅠ期,Ⅱ期及塌陷较小的 ⅢA期股骨头坏死的患者。     

激素性股骨头坏死与他汀类药物的修复治疗作用

背景：近年来随着器官移植技术在临床上的广泛开展,糖皮质激素引起股骨头缺血性坏死占到首位,且并有逐年增高的趋势。 目的：主要对他汀类药物治疗股骨头坏死的机制进展进行综述分析,为进一步的实验研究及临床应用奠定基础。 方法：第一作者应用计算机检索CNKI、PubMed、万方和维普数据库中1980-01/2010-12关于他汀类药物在治疗股骨头坏死机制的文章,在标题和摘要中以“股骨头坏死;他汀类药物;糖皮质激素;成骨细胞”或“ONFH;Corticosteroids;  statins;  Osteoblasts”为检索词进行检索。选择文章内容与激素性股骨头坏死与他汀类药物修复治疗相关,同一领域文献则选择近期发表或发表在权威杂志文章。排除陈旧及重复实验文章,初检得到169篇文献,根据纳入标准选择34篇文章进行综述。 结果与结论：股骨头缺血性坏死是骨科常见,多发性的疾病,其治疗是世界性的难题。他汀类药物能有效纠正激素所导致机体内脂质代谢紊乱的状态,减轻股骨头内的骨细胞损害,可以延缓或阻止股骨头缺血坏死、塌陷、变形的病理过程。     

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。     

医用多孔钽的性能及其在膝关节损伤中的应用

背景：随着临床上大量金属支架材料在人体的广泛应用,很多金属材料表现出一些相对不足,但是医用多孔钽金属在许多临床和科研中性能发挥稳定,逐渐成为新的骨组织工程发展方向。 目的：综述多孔钽金属的结构特性、力学性能、生物特性及其在膝关节损伤中的应用情况。 方法：应用计算机检索1955-12/2010-01中国期刊全文数据库和PubMed数据库,英文检索词为“porous tantalum,bone tissue project,biological material,trabecula metal”,中文检索词为“多孔钽,骨组织工程,生物材料,小梁金属”,共检索到文献81篇。 结果与结论：医用多孔钽在结构特性方面具有的三维多孔结构,有利于成骨细胞黏附、分化和生长,促进骨长入;在力学性能方面多孔钽的弹性模量、抗疲劳特性、摩擦系数与正常骨组织相近;在生物特性方面多孔钽表现出良好的生物相容性、抗腐蚀性、骨诱导和再生能力;在膝关节损伤应用方面有着广阔的发展前景,但是目前医用多孔钽在国内应用较少,而且研究不够深入,这就有待于人们去更深入的研究和探索。     

骨小梁金属AVN重建棒在早期股骨头坏死中的应用:2年45髋临床观察

背景:以往股骨头骨坏死的治疗方法多采用髓芯减压和某种植骨。但单纯髓芯减压缺少对软骨下骨板的结构支撑,血管蒂腓骨移植容易出现包括取骨区伴发的病损、延长的手术时间、失血以及在康复过程中的并发症。目的:评定采用多孔钽置入联合髓芯减压治疗股骨头坏死髋关节的生存率。方法:选择股骨头坏死Ⅰ期和Ⅱ期塌陷前的患者40例(45髋),男32例,女8例,年龄29.5(20～40)岁。采用联合多孔钽置入联合髓芯减压治疗股骨头坏死,置入前后Harris评分评价髋关节功能,影像学评估并发症情况。结果与结论:40例患者手术均顺利完成,无意外发生,均获得随访,12例随访24个月,18例随访12个月,10例随访6个月。40例患者术后关节功能均较术前明显改善,影像学显示坦棒均正确置入相应区域,未出现异常的骨密度、塌陷、假体松动及放射性透光线的表现。说明采用多孔钽置入物联合髓芯减压治疗股骨头坏死,可延缓或预防关节软骨的逐渐塌陷。     

骨髓间充质干细胞治疗早期股骨头坏死的应用与前景

文题释义： 骨髓间充质干细胞修复股骨头坏死：骨髓间充质干细胞是来源于中胚层的具有多向分化潜能的干细胞,单个细胞呈纺锤状或者梭形,整体呈菊花状或同心圆状排列。骨髓间充质干细胞具有增殖和分化特性,使其在股骨头再生领域脱颖而出。促进骨髓间充质干细胞成骨分化同时抑制其成脂分化是目前治疗股骨头坏死的关键。 股骨头坏死：股骨头坏死是一个病理演变过程,初始发生在股骨头的负重区,应力作用下坏死骨骨小梁结构发生损伤即显微骨折以及随后针对损伤骨组织的修复过程。造成骨坏死的原因不消除,修复不完善,损伤-修复的过程继续,导致股骨头结构改变、股骨头塌陷、变形、关节炎症、功能障碍。 背景：股骨头坏死为骨科常见的致残性进展性疾病,其病情发展难以逆转,最终导致髋关节功能丧失,严重影响患者的生活质量。 目的：对骨髓间充质干细胞治疗早期股骨头坏死的研究进展做一综述。 方法：以“BMSCs,ONFH”为关键词检索PubMed英文数据库,以“骨髓间充质干细胞、股骨头坏死”为关键词检索CNKI、万方中文数据库。检索时限为2001年1月至2019年4月,排除与文章研究目的无关及重复性文章,纳入符合标准的42篇文献进行综述。 结果与结论：骨髓间充质干细胞潜在修复股骨头,不仅提供修复前体细胞,还分泌细胞因子和生长因子,启动股骨头内细胞愈合过程。大量的实验与临床研究表明,骨髓间充质干细胞治疗早期股骨头坏死是一种可行的方法。 ORCID: 0000-0001-8205-0279(王田田) 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

传染性非典型肺炎后股骨头坏死的病因及治疗

背景：大部分非典型肺炎患者在康复早期出现了不同程度的髋关节滑囊炎并逐步发展为股骨头坏死。 目的：分析非典型肺炎后遗症股骨头坏死各种病因,并介绍股骨头坏死治疗方法。 方法：由第一作者应用计算机检索PubMed、中国期刊全文数据库(CNKI)、维普数据库和万方数据库1997年1月至2012年8月相关文献。在标题、摘要、关键词中以“传染性非典型肺炎,后遗症,股骨头坏死,骨缺血,病因,传染性非典型肺炎病毒,保守治疗,手术治疗,全髋置换”或“infectious atypical pneumonia sequela, femoral head necrosis, bone ischemia, etiology, infectious atypical pneumonia virus, conservative treatment, operation treatment, total hip replacement”为检索词进行检索,初检得到872篇,最终选择56篇文献进行综述。 结果与结论：传染性非典型肺炎后遗症股骨头坏死与患者在治疗过程中使用激素剂量大小、使用时间长短、患者对激素敏感程度及使用的方法及患者本身分泌的瘦素及骨降钙素量的多少有密切关系,还与传染性非典型病毒本身的作用有密切关系。由于这些病因导致股骨头坏死,先采用保守治疗减慢股骨头坏死的进程,延迟假体的置换,最终大部分患者还是采用手术治疗,传染性非典型肺炎后遗症股骨头坏死晚期置入假体置换是治疗股骨头坏死最好的结果。     

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.     

多孔钽金属置入治疗早期股骨头坏死的研究与应用现状

BACKGROUND: Porous tantalum rod implantation is a relatively new technique that has been applied to patients with early-stage osteonecrosis of the femoral head, but its efficacy is mixed. OBJECTIVE: To review the etiology and pathogenesis of osteonecrosis of the femoral head and the latest research progress of porous tantalum rod implantation. METHODS: A computer-based search of PubMed and CNKI database was performed for articles related to the pathogenesis of osteonecrosis of the femoral head and porous tantalum rod implantation published from 1985 to 2015. The key words were “osteonecrosis of the femoral head, etiology, porous tantalum rod, tissue engineering, nanomaterials, bone marrow mesenchymal stem cells” in Chinese and English in the title and abstract. Finally, 67 articles were included in result analysis. RESULTS AND CONCLUSION: The porous tantalum rod is considered effective for early-stage osteonecrosis of the femoral head patients in short term. More recently, the porous tantalum rod implantation combined with other therapies, such as stem cell transplantation, has developed for long-term reserving the hip in early-stage osteonecrosis of the femoral head. Therefore, we need further clinical trials for long-term follow-up to give a final clinical and socioeconomic assessment of porous tantalum rod implantation. Moreover, the most effective approach and position of porous tantalum rod implantation have not been reported until now.       

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。     

不同病因致股骨头缺血性坏死的影像对比

背景：股骨头缺血性坏死的临床诊断主要依靠影像学检查,对不同病因所致股骨头缺血性坏死的影像学对比研究目前报道甚少。 目的：对不同病因股骨头缺血性坏死的影像学表现进行比较研究,观察不同病因股骨头缺血性坏死的影像学表现有无差别。 方法：收集经临床及影像学检查证实的股骨头缺血性坏死54例共计60个髋关节影像资料,根据病因将其分为特发性、酒精性、激素性、股骨颈骨折性4类,将这4类股骨头缺血坏死的X射线、CT、MRI表现进行对比分析。 结果与结论：60个股骨头缺血性坏死髋关节中特发性12个、酒精性21个、激素性15个、股骨颈骨折性12个。X射线、CT主要表现依次为：股骨头“星征”变形或 “星征”消失;“新月”征阳性,骨质轻度碎裂,关节面轻度塌陷;股骨头变形,骨质碎裂,关节面塌陷,髋关节退性行改变,并以CT更可靠。股骨头缺血性坏死分期MRI均表现为：Ⅰ期T1WI股骨头负重区显示线样低信号、T2WI 加权呈高信号为主要改变;Ⅱ期T1WI为新月形边界清楚的不均匀信号,T2WI加权呈中等稍高信号,周围不均匀稍低信号环绕,呈典型的双线征;Ⅲ期股骨头变形,软骨下骨折、塌陷、新月体形成。T1WI呈带状低信号, T2WI示中等或高信号;Ⅳ、Ⅴ期关节软骨被完全破坏,关节间隙变窄,股骨头显著塌陷变形,髋臼出现硬化、囊性变及边缘骨赘等非特异性继发性骨关节炎。提示不同病因相同分期股骨头缺血性坏死的X射线、CT、MRI表现特点及规律是相同的。