多孔钽金属棒治疗股骨头坏死的短期临床疗效

目的探讨多孔钽金属棒治疗股骨头坏死的短期临床疗效。方法从2008年8月至2009年12月,使用多孔钽金属棒植入治疗股骨头坏死26例共33髋,男14例18髋,女12例15髋。根据Steinberg分期：Ⅱ期15髋、Ⅲ期16髋和Ⅳ期2髋。术中经外侧小切口行髓芯减压,必要时在坏死腔中置入不规则颗粒人工骨,最后植入多孔钽金属棒。术后禁止负重4周后开始部分负重4周,随后逐渐过渡到完全负重。定期随访X线及Harris评分,评估术后患髋功能的改善情况。结果所有26例共33髋全部获得随访。平均随访24.2（20.0～30.5）个月。术后末次随访Harris评分为（85.7±7.9）分,较术前（65.9±10.1分）改善为19.8分（P〈0.05）。关节功能优11髋（33.3%）,良16髋（48.5%）,可4髋（12.1%）,差2髋（6.0%）。仅1髋术后2年出现关节面塌陷,余各假体位置良好,股骨头无进一步塌陷。结论多孔钽金属棒为股骨头坏死患者（Ⅲ期前及ⅢA期）提供了一种新的治疗选择。

Short term clinical outcome of porous tantalum rod for the treatment of osteonecrosis of femoral head

Objective To evaluate the short term clinical outcome of a Porous Tantalum rod for the treatment of osteonecrosis of femoral head. Methods From August 2008 to December 2009, 26 patients (33 hips)who had undergone core decompression in combination with porous tantalum implant in our hospital were enrolled in this study. 15 hips were Steinberg stage Ⅱ, 16 hips were stage Ⅲ, and two hips were stage Ⅳ.Small incision at lateral side was used for core decompression. Irregular grains of artificial bone were planted into necrotic cavity when neccssary and porous tantalum rod was implanted at the last step. Patients were instructed to be non-weightbearing for four weeks, and partial-weightbearing for the next four weeks,and gradually be full-weight bearing as long as they can tolerate. All patients were evaluated both clinically and radiographically. The functional improvement was assessed by the Harris hip score. Results Totally 26 patients (33 hips)were followed up and the duration time were 20.0~30.5 months with an average of 24.2 months. In the last postoperative follow-up, the preoperative score and post-operative score were (65.9±10.1) and (85.7±7.9) respectively in average, which improved 19.8 points (P<0.05). According to the Harris hip score system, there were "excellent" for 11 hips, "good" for 16 hips, "fair" for four hips, and "poor" for two hips. All the implantations were radiographically excellent except one hip which suffered femoral head collapse two years after the operation. Conclusions Core decompression in combination with porous tantalum implant is fast and easy. It can avoid pain, give structural support in necrotic regions of femoral head, and provide a new surgical choice for the patients with osteonecrosis of femoral head (Before Steinberg stage Ⅲ and stage ⅢA).