本文選題：股骨頭壞死 + 多孔鉭棒�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景和目的:股骨頭壞死(Osteonecrosis of femoral head,ONFH)也被稱作股骨頭缺血性壞死(avascularnecrosis,AVN),是骨科的常見疾病。疾病常呈進(jìn)展性發(fā)展,80%以上的病人最終會(huì)進(jìn)展為股骨頭塌陷[1,2]。疾病晚期嚴(yán)重影響患者髖關(guān)節(jié)功能,因此對(duì)于疾病的早期治療便顯得尤為重要,疾病早期常選用多種保髖治療方案。鉭棒植入便是臨床上常用的保髖治療方案之一,鉭棒是由鉭金屬制成的多孔蜂窩狀立體結(jié)構(gòu),具有與人體骨組織相近的抗壓強(qiáng)度和彈性模量,其硬度也適用于傳導(dǎo)生理負(fù)重,并且具有良好的生物相容性和安全性,因此可被用作髓芯減壓后的植入物治療早期股骨頭壞死。近年來(lái)針對(duì)鉭棒植入治療早期股骨頭壞死的療效存在較大爭(zhēng)議,因此本研究旨在探究髓芯減壓聯(lián)合多孔鉭棒植入治療早期股骨頭壞死的臨床療效,評(píng)估其術(shù)后效果。分析失敗病例并探尋影響鉭棒植入術(shù)后效果的因素,借以指導(dǎo)鉭棒植入的適應(yīng)征的選擇。方法:選取自2009年3月至2017年2月就診于山東大學(xué)齊魯醫(yī)院骨科行髓芯減壓聯(lián)合多孔鉭棒植入術(shù)患者,共隨訪成功16例患者(17髖),其中男性患者14例(15髖),女性患者2例(2髖),平均年齡為36.41 ±7.88歲(20～54),股骨頭壞死分期選用Steinberg分期[3],其中Ⅰ期5髖,Ⅱ期12髖。按病因分類:酒精型7髖,激素型4髖,特發(fā)型6髖。分析資料來(lái)源于患者住院臨床病例資料,統(tǒng)計(jì)信息包括病人術(shù)前基本信息(性別、年齡、身高、體重、病程、癥狀、體征、影像學(xué)資料如髖關(guān)節(jié)MRI及X線),患者手術(shù)記錄中的相關(guān)信息(包括手術(shù)時(shí)間、術(shù)中出血量、術(shù)中植入鉭棒的規(guī)格等),術(shù)后恢復(fù)情況(如術(shù)后傷口恢復(fù)情況、功能鍛煉情況及有無(wú)術(shù)后并發(fā)癥的出現(xiàn)),術(shù)前術(shù)后髖關(guān)節(jié)Harris評(píng)分,以行全髖關(guān)節(jié)置換作為終點(diǎn)事件,對(duì)于已行THA手術(shù)患者選取其THA術(shù)前評(píng)分作為末次隨訪評(píng)分參與統(tǒng)計(jì)分析。結(jié)果:1.平均隨訪時(shí)間36.88 ±28.81個(gè)月(2～90),術(shù)前平均Harris評(píng)分65.06±21.80分(22～96),術(shù)后切口均一期愈合,未出現(xiàn)傷口感染、不愈合、傷口破裂出血、深部血管栓塞、血管神經(jīng)損傷、鉭棒松動(dòng)及斷裂等術(shù)后并發(fā)癥。2.隨訪期間有4例患者股骨頭呈進(jìn)展性塌陷,其中3例已行全髖關(guān)節(jié)置換術(shù),1例暫行保守治療。末次隨訪Harris評(píng)分平均82.94± 19.66分(36～100)。以Harris評(píng)分90～100分為優(yōu),80～89分為良,70～79分為可,70分為差。末次隨訪Harris評(píng)分中:11例為優(yōu),2例為良,可0例,4例為差,末次隨訪Harris評(píng)分優(yōu)良率為76.47%。術(shù)前術(shù)后Harris評(píng)分差別有統(tǒng)計(jì)學(xué)意義,P0.05(P=0.044)。3.分析手術(shù)效果的影響因素,如病因、患者年齡、術(shù)前評(píng)分、隨訪時(shí)長(zhǎng)(月)、體重指數(shù)(BMI)、術(shù)前發(fā)病時(shí)間(月)、術(shù)前Steinberg分期、術(shù)中植入鉭棒規(guī)格、手術(shù)時(shí)間(min)、術(shù)中出血(ml)、術(shù)后住院天數(shù)等,結(jié)果提示髓芯減壓聯(lián)合鉭棒植入術(shù)對(duì)酒精型股骨頭壞死的手術(shù)效果優(yōu)于激素型及特發(fā)型;術(shù)前評(píng)分、Steinberg分期以及術(shù)前發(fā)病天數(shù)對(duì)術(shù)后Harris評(píng)分的影響具有統(tǒng)計(jì)學(xué)差異。術(shù)前Harris評(píng)分和術(shù)前Steinberg分期與術(shù)后效果呈負(fù)相關(guān),術(shù)前發(fā)病時(shí)間對(duì)術(shù)后效果的影響也具有顯著差異,其系數(shù)為正,表明術(shù)前發(fā)病時(shí)長(zhǎng)與術(shù)后效果呈正相關(guān)。結(jié)論:隨訪自2009年3月至2017年2月就診于齊魯醫(yī)院骨科行髓芯減壓聯(lián)合多孔鉭棒植入術(shù)患者16例患者(17髖),對(duì)比術(shù)前術(shù)后髖關(guān)節(jié)Harris評(píng)分,對(duì)于股骨頭壞死進(jìn)展已行THA手術(shù)患者選取其THA術(shù)前評(píng)分作為末次隨訪評(píng)分參與統(tǒng)計(jì)分析,分析對(duì)比術(shù)前術(shù)后效果,探究手術(shù)效果影響因素。結(jié)果顯示末次隨訪優(yōu)良率為76.47%,對(duì)比國(guó)內(nèi)外相關(guān)文獻(xiàn),本組患者鉭棒植入術(shù)具有較好的術(shù)后優(yōu)良率,考慮原因?yàn)楸窘M患者術(shù)前Steinberg分期均為Ⅰ期及Ⅱ期,無(wú)Ⅲ期及Ⅲ期以上患者,就診于我院的Ⅲ期患者常選用肌骨瓣植入等手術(shù)方式,因此術(shù)后效果較好。髓芯減壓聯(lián)合鉭棒植入術(shù)具有手術(shù)操作簡(jiǎn)單、平均手術(shù)時(shí)間短、術(shù)中失血少的優(yōu)勢(shì),是治療早期股骨頭壞死一種低創(chuàng)傷的、有效的治療方法。手術(shù)患者術(shù)后的髖關(guān)節(jié)Harris評(píng)分較術(shù)前有明顯提高且差距具有統(tǒng)計(jì)學(xué)意義,P0.05。表明鉭棒植入術(shù)可以改善早期股骨頭壞死患者的癥狀,尤其是可以明顯緩解疼痛癥狀,可以恢復(fù)髖關(guān)節(jié)功能,延緩疾病的進(jìn)展,推遲或避免THA的轉(zhuǎn)歸,是早期股骨頭壞死的一種切實(shí)可行的治療方法,尤其適用于酒精型股骨頭壞死患者及Steinberg分期Ⅰ期和Ⅱ期的患者,不建議應(yīng)用于Steinberg分期或ARCO分期Ⅲ期或Ⅲ期以上患者。
[Abstract]:Background and purpose: Osteonecrosis of femoral head (ONFH) is also known as avascularnecrosis (AVN). It is a common disease in the Department of orthopedics. The disease is often progressing, and more than 80% of the patients will eventually develop the hip joint function in the late stage of the femoral head collapse [1,2]. disease. Early treatment of the disease is particularly important. A variety of hip conservation treatments are often used early in the disease. Tantalum rod implantation is one of the most commonly used hips in clinical. The tantalum rod is a porous honeycomb structure made of tantalum metal, which has the compression strength and modulus of elasticity similar to that of human bone tissue. The hardness of tantalum rod is also suitable for conduction physiology. Weight negative, good biocompatibility and safety, and therefore can be used as an implant after core decompression for the treatment of early femoral head necrosis. In recent years, the effect of tantalum rod implantation in the treatment of early femoral head necrosis has been controversial. Therefore, the aim of this study is to explore the combination of core reduction and porous tantalum implantation for the treatment of early femoral head injury. The clinical effect of death was evaluated and the results were evaluated. The failure cases were analyzed and the factors affecting the effect of tantalum rod implantation were explored to guide the selection of the indications of tantalum rod implantation. Methods: from March 2009 to February 2017, the patients who visited the Department of orthopedics, Qilu Hospital of Shandong University were treated with core decompression combined with porous tantalum rod implantation, and 1 successful patients were followed up. 6 cases (17 hips), of which 14 cases (15 hips) and 2 cases (2 hips) in female patients, the average age was 36.41 + 7.88 years (20~54). Steinberg staging of femoral head necrosis was selected by [3], including 5 hips and 12 hips of stage II. According to the etiology: alcoholic 7 hip, hormone 4 hip, and specially developed 6 hips. Analysis data were derived from clinical data of patients hospitalized, The statistical information included basic preoperative information (gender, age, height, weight, course of disease, symptoms, signs, imaging data such as MRI and X-ray of the hip), related information in the patient's surgical records (including operation time, intraoperative bleeding, tantalum bars in the operation, etc.), and postoperative recovery (such as postoperative wound recovery, functional exercise) The Harris score of hip joint before and after operation was taken as an end point of total hip arthroplasty. The THA preoperative score was selected as the final follow-up score for the patients who had been operated on THA operation. The results were as follows: the average follow-up time was 36.88 + 28.81 months (2~90), and the average Harris score was 65.06 + 21.8 before the operation. 0 points (22~96), postoperative wound healing, no wound infection, nonunion, rupture and bleeding, deep vascular embolization, vascular nerve injury, tantalum rod loosening and fracture in 4 patients with progressive collapse of femoral head during follow-up period, of which 3 cases had total hip arthroplasty and 1 cases were temporarily conservative. The last follow-up was followed up. The average score of Harris was 82.94 + 19.66 (36~100). The score of Harris was 90~100 good, 80~89 was good, 70~79 was good, and 70 was poor. In the last follow-up Harris score, 11 cases were excellent, 2 was good, 0, 4 were poor, and the fine rate of the last follow-up Harris score was 76.47%. The difference of Harris score before and after operation was statistically significant, P0.05 (P=0.044 .3. analysis of the influencing factors, such as the cause of the operation, the age of the patients, the preoperative score, the long (month), the body mass index (BMI), the preoperation time (month), the preoperative Steinberg staging, the tantalum stick specification, the operation time (min), the intraoperative bleeding (ML), the number of days after the operation, and so on, the results suggested that the core decompression combined with tantalum implantation for alcohol type femur. The effect of osteonecrosis is better than that of hormone type and special type. Preoperative score, Steinberg staging and the number of pre operation days have statistically significant difference in the effect of postoperative Harris score. The preoperative Harris score and preoperative Steinberg staging are negatively correlated with the postoperative effect, and the effect of pre operation time on postoperative effect is also significantly different. The number is positive, indicating a positive correlation between the length of the preoperation and the postoperative effect. Conclusion: from March 2009 to February 2017, 16 patients (17 hips) were treated in the Department of orthopedics of Qilu Hospital of the Qilu Hospital with porous tantalum rod implantation. Compared with the Harris score of the hip joint before and after the operation, the patients with the necrosis of the femoral head had been selected for their THA. The preoperative score was used as the final follow-up score for statistical analysis. The results were analyzed and compared before and after the operation. The results showed that the excellent rate of the last follow-up was 76.47%. Compared with the relevant literature at home and abroad, the group of patients with tantalum rod implantation had good postoperative good rate. The reason for this was the Steinberg staging of the patients in this group. For stage I and stage II, there is no stage III and stage III patients, and the patients in stage III of the hospital are often treated with musculoskeletal flap implantation. Therefore, the effect is better after the operation. The combined operation of core decompression and tantalum rod implantation has the advantages of simple operation, short operation time and less blood loss during the operation, which is a low trauma for the treatment of early femoral head necrosis. Effective treatment. The Harris score of the hip joint after operation is significantly higher than that before operation and the gap is statistically significant. P0.05. shows that tantalum rod implantation can improve the symptoms of early femoral head necrosis, especially to relieve the pain symptoms, restore the hip function, delay the progression of the disease, postpone or avoid the disease. THA free transfer is a practical treatment for early femoral head necrosis, especially for patients with alcoholic femoral head necrosis and Steinberg stage I and stage II, and is not recommended for patients with Steinberg or ARCO stages of stage III or stage III.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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