摘要
目的:评估支撑股骨头塌陷的空芯钛棒设计的可行性及临床实用性。方法:2003年1月至2007年6月对36例(46髋)股骨头囊性变的患者进行手术治疗,男20例,女16例;年龄18～56岁,平均40岁;病程10～24个月,平均16个月。其中NFH Ⅱ期(ARCO分期)24例(34髋,Ⅱa期11髋、Ⅱb期13髋、Ⅱc期10髋),骨纤维结构不良6例,单纯骨囊肿4例,软骨黏液样纤维瘤2例。在X线透视定位监视下,经皮微创行髓芯减压病灶清除加植入组织工程骨,并钛棒支撑股骨头软骨下骨质。术后1、3、6、12、24、36个月进行随访,通过X线进行临床评价,以稳定、不稳定、失败为评价指标,参数比较采用SPSS13.5软件行Fisher确切概率法;以股骨头软骨下骨塌陷作为失败终点的生存率,采用Kaplan-Meier生存曲线分析。结果:术后1～12个月各时间段无不稳定和失败病例,说明术后12个月内空芯钛棒支撑股骨头防止塌陷的效果肯定;术后12～24个月,有不稳定或失败病例,稳定率下降,主要发生在NFH Ⅱc期,但此期与术后12个月以前各时间段稳定率比较无统计学差异(P>0.05),证明此阶段空芯钛棒支撑股骨头防止塌陷是可行的;术后36个月原有的不稳定病例进展为失败1例,但未出现新的不稳定病例,稳定率与不稳定率均无变化,失败率上升,各时间段稳定率比较无统计学差异(P=0.197>0.05),说明空芯钛棒支撑股骨头防止塌陷的可行性作用依然稳定持久;依据病因学的差异,与NFH有关的Ⅱc期病变3年生存率最低70%,其他病因所至生存率为90.2%。结论:支撑股骨头塌陷的空芯钛棒设计具有可行性,除了对NFHⅡc期病变应慎重选择外,对股骨头囊性病变在治疗的同时行钛棒支撑,防止股骨头塌陷方面临床实用性强且效果肯定。
Objective：To evaluate the feasibility and the clinical practicality of the design about the hollowed titanium stick supporting the femoral head and preventing it from collapsing.Methods：From Jan.2003 to Jun.2007,36 patients（46 hips） diagnosed as cystis degeneration of the femoral head were treated by surgical operation,including 20 males and 16 females with an average age of 40 years ranging from 18 to 56 years old,and the course of the disease was from 10 to 24 months（16 months on average）.According to ARCO staging,there were 24 patients（34 hips） in NFH Ⅱ,of which 11 hips were Ⅱa stage,13 hips were Ⅱb stage and 10 hips were Ⅱc stage;there were 6 patients diagnosed as osteofibrous,4 patients as simple bone cyst and 2 patients as chondromyxoid fibroma.Under X-ray the percutaneous narrow core decompression and focus infection elimination were performed and supported the sclerotin under the cartilage with titanium stick.The patients were followed-up at the first,third,sixth,twelfth,twenty-fourth and thirty-sixth month after the operation.The clinical evaluation was done by X-ray and the indexes included stable,unstable and abortive.The data was analyzed by Fisher exact probility and the suviaval rate was analyzed by Kaplan-Meier suviaval curve using statistical soft ware SPSS13.5.Results：There were no unstable or failure cases on each period from the 1st month to the 12th month after the operation,indicating that the supporting effect of the titanium stick was exact during 12 months after the operation.There were unstable and failure cases from the 12th month to the 24th month after the operation,which were mainly in stage NFH Ⅱc but the comparision of the stable rate in this period and 12 months after the operation had no obvious statistical differences（P〉0.05） indicating that the supporting effect of the titanium stick was feasible during the stage.One of the unstable cases deteriorated and failed but there were no new unstable cases,both the stable rate and the unstable rate had no change and the failure rate rose on the 36th month after the operation.The comparision of the stable rate on each period after the operation had no obvious difference（P=0.1970.05）,which indicated that the supporting effect of the titanium stick was persistent.By the difference of the etiology the three-year survival rate of the relevant NFH Ⅱc pathological changes was the lowest-70% and the survival rate of the pathological changes induced by other etiological factors was 90.2%.Conclusion：The design about the hollowed titanium stick supporting the collapsed femoral head is feasible.Using the hollowed titanium stick to support the femoral head and prevent it from collapsing is pragmatic in the clinical and the effect is positive,however,when it comes to the NFH Ⅱc pathological changes,the choice should be made discreetly.
出处
《中国骨伤》
CAS
2011年第7期564-569,共6页
China Journal of Orthopaedics and Traumatology
关键词
股骨头
囊性纤维化
骨折固定术
内
外科手术
Femur head
Cystic fibrosis
Fracture fixation
internal
Surgical procedures
operative
