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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2022, Vol. 17 ›› Issue (03) : 198 -206. doi: 10.3877/cma.j.issn.1673-9450.2022.03.004

论著·股骨头坏死

多孔钽棒植入术治疗股骨头坏死的中长期疗效及术后失效行THA与初次行THA疗效比较
何敏聪1, 何伟1,†(), 魏秋实1, 张庆文1, 陈镇秋2, 何晓铭1, 林天烨3   
  1. 1. 510378　广州，广东省中医骨伤研究院；510378　广州中医药大学第三附属医院关节中心；510378　广州中医药大学髋关节研究中心
    2. 510405　广州中医药大学第一附属医院骨科
    3. 510378　广州，广东省中医骨伤研究院
  • 收稿日期:2022-03-25 出版日期:2022-06-01
  • 通信作者: 何伟
  • 基金资助:
    国家自然科学基金青年科学基金(82004392); 广州中医药大学"双一流"学科建设项目(Z2015002); 广州中医药大学"双一流"与高水平大学学科协同创新团队项目(2021XK05, 2021XK41, 2021XK46); 广州中医药大学第一附属医院高水平手术项目(211020030705); 广东省教育厅高校科研项目青年创新人才项目(2019KQNCX017)

Medium-long term clinical outcomes of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head and efficacy comparison of THA postoperative failure and primary THA

Mincong He1, Wei He1,†(), Qiushi Wei1, Qingwen Zhang1, Zhenqiu Chen2, Xiaoming He1, Tianye Lin3   

  1. 1. Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou 510378, China; Joint Center, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, China; Hip Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510378, China
    2. Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
    3. Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou 510378, China
  • Received:2022-03-25 Published:2022-06-01
  • Corresponding author: Wei He
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引用本文：

何敏聪, 何伟, 魏秋实, 张庆文, 陈镇秋, 何晓铭, 林天烨. 多孔钽棒植入术治疗股骨头坏死的中长期疗效及术后失效行THA与初次行THA疗效比较[J]. 中华损伤与修复杂志(电子版), 2022, 17(03): 198-206.

Mincong He, Wei He, Qiushi Wei, Qingwen Zhang, Zhenqiu Chen, Xiaoming He, Tianye Lin. Medium-long term clinical outcomes of porous tantalum rod implantation in the treatment of osteonecrosis of the femoral head and efficacy comparison of THA postoperative failure and primary THA[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(03): 198-206.

目的

评估接受髓心减压、同种异体骨植骨、多孔钽棒植入术(简称多孔钽棒植入术)治疗的股骨头坏死(ONFH)患者的中长期临床疗效以及术后失效是否会影响后续全髋关节置换术(THA)的临床效果。

方法

选择2008年1月至2011年12月广州中医药大学髋关节研究中心收治的非创伤性ONFH患者38例40髋。所有患髋均行多孔钽棒植入术。在透视下先行股骨头内髓内减压，清除部分死骨并行同种异体骨植骨，最后旋入1枚多孔钽棒。多孔钽棒植入术失效后行THA的患者设为二次手术组(n＝12)，二次手术组行THA时，行股骨颈截骨同时截断植入钽棒，同时取出近端残端。按照1例二次手术组患者匹配4~6例性别、年龄相近(±15岁)原则纳入非创伤性ONFH[国际骨循环研究会(ARCO) Ⅳ期]既往无保髋手术史、初次行THA的患者57例，设为对照组。对照组患者行初次THA。分析及比较总体患者、不同ARCO期、不同日本骨坏死调查委员会(JIC)型ONFH患者多孔钽棒植入术术后24、60、96个月的保髋率。评估总体患者、不同ARCO期、不同JIC型ONFH患者多孔钽棒植入术术后24、60、96个月的Harris髋关节评分。同时比较二次手术组与对照组患者术前、术后60个月的Harris髋关节评分。收集所有患者患髋的正位、蛙位X线片，以及MRI和CT扫描数据，采用改良的Nish Ⅱ方法评估髋关节塌陷的进展并计算末次随访影像学进展率；比较末次随访时影像学进展的不同ARCO期、不同JIC型ONFH患者的保髋率。数据行Wilcoxon符号秩检验、Mann Whitney U检验与χ2检验。

结果

接受多孔钽棒植入术后平均随访(117.1±4.1)个月。术后24、60、96个月的保髋率分别为92.5%(37/40)、82.5%(33/40)、75%(30/40)。术后24、60个月，ARCO Ⅱ期患者与ARCO Ⅲ期患者保髋率比较，差异均无统计学意义(χ2＝0.001、1.396，P＝1.000、0.457)；术后96个月，ARCO Ⅱ期患者保髋率[89.6%(23/27)]比ARCO Ⅲ期患者[53.8%(7/13)]高，差异有统计学意义(χ2＝4.596，P＝0.042)。术后24、60个月，JIC C1型患者与JIC C2型患者保髋率比较，差异均无统计学意义(χ2＝0.041、0.145，P＝0.839、0.703)；术后96个月，JIC C1型患者保髋率[83.3%(25/30)]比JIC C2型患者[50.0%(5/10)]高，差异有统计学意义(χ2＝4.444，P＝0.035)。多孔钽棒植入术术前，ONFH患者Harris髋关节评分为59 (55，61)分，术后24、60、96个月Harris髋关节评分分别为72(61，80)、89(82，91)、94(91，96)分，比较差异有统计学意义(Z＝4.627，P<0.05)。术前，术后60、96个月，ARCO Ⅱ期患者与ARCO Ⅲ期患者Harris髋关节评分比较，差异均无统计学意义(Z＝123.5、180.0、101.0，P＝0.114、0.994、0.871)；术后24个月，ARCO Ⅱ期与ARCO Ⅲ期患者Harris髋关节评分比较，差异有统计学意义(Z＝100.0，P＝0.043)。术前，术后96个月，JIC C1型患者与JIC C2型患者Harris髋关节评分比较，差异均无统计学意义(Z＝164.0、90.0，P＝0.279、0.355)；术后24、60个月，JIC C1型患者与JIC C2型患者Harris髋关节评分比较，差异均有统计学意义(Z＝96.5、93.0，P＝0.042、0.038)。末次随访总体影像学进展率为55.0%(22/40)。ARCO Ⅱ期患者影像学进展率为48.1%(13/27)，与ARCO Ⅲ期患者[69.2%(9/13)]相比，差异无统计学意义(χ2＝1.255，P＝0.391)；JIC C1型患者影像学进展率为46.7% (14/30)，与JIC C2型患者[80%(8/10)]相比，差异无统计学意义(χ2＝1.835，P＝0.086)。影像学进展的ARCO Ⅲ期患者保髋率[11.1%(1/9)]与影像学进展的ARCO Ⅱ期患者保髋率[76.9%(10/13)]相比，差异有统计学意义(χ2＝3.035，P＝0.024)。影像学进展的JIC C2型患者保髋率[12.5%(1/8)]与影像学进展的JIC C1型患者髋关节的保髋率[71.4%(10/14)]相比，差异有统计学意义(χ2＝2.659，P＝0.009)。二次手术组、对照组接受THA术前、术后60个月Harris髋关节评分比较差异均有统计学意义(Z＝6.511、7.471，P<0.05)。术后60个月，二次手术组、对照组Harris髋关节评分分别为88 (85，93)、94 (92，96)分，比较差异均无统计学意义(Z＝-1.711，P＝0.090)。

结论

多孔钽棒植入术治疗ONFH在中长期的随访中，ARCO Ⅱ期、JIC C1型患者保髋率较高，ARCO Ⅲ期或JIC C2型患者效果一般，应用该技术的关键在于选择合适的患者。晚期ONFH患者行THA和多孔钽棒植入术失效后接受THA的患者的临床效果相似。

关键词: 股骨头坏死, 关节成形术，置换，髋, 多孔钽棒植入术, 髋关节Harris评分
Objective

To evaluate the medium-long term clinical outcomes of osteonecrosis of the femoral head (ONFH) patients treated with decompression of the femoral head, allograft, and porous tantalum rod implantation (porous tantalum rod implantation for short), and whether postoperative failure would affect the clinical outcomes of subsequent total hip arthroplasty (THA).

Methods

A total of 38 patients (40 hips) with non traumati ONFH admitted to Hip Research Center, Guangzhou University of Chinese Medicine from January 2008 and December 2011 were selected. All affected hips were implanted with porous tantalum rod implantation. Intramedullary decompression of the femoral head was performed under fluoroscopy to remove part of the dead bone and allograft bone. Finally, a porous tantalum rod was inserted. Patients who underwent THA after the failure of porous tantalum rod implantation were assigned to the second surgery group (n=12). In the second surgery group, femoral neck osteotomy was performed and tantalum rod was truncated and implanted, and the proximal residual end was removed at the same time. Fifty-seven patients who had no previous history of hip preservaton surgery and underwent primary THA in non traumatic ONFH [Association Research Circulation Osseous Committee (ARCO) Ⅳ] were included as the control group according to the principle that 1 patient in the second surgery group was matched with 4-6 patients of similar gender and age (±15 years old). Primary THA was performed in the control group. The hip preservation rates of patients at 24, 60 and 96 months after porous tantalum rod implantation were analyzed and compared in the whole population, different ARCO stages and different Japanese Osteonecrosis Investigation Committee (JIC) ONFH patients. The hip preservation rates of patients with different radiographically progressive of ARCO stages and different JIC types of ONFH were compared at the last follow-up. Harris hip scores at 24, 60, and 96 months after porous tantalum rod implantation were evaluated in the population, different ARCO stages, and different JIC types of ONFH. Harris hip scores of the second surgery group and the control group were compared before and 60 months after surgery. Anteroposterial and frog radiographs, as well as MRI and CT scan data were collected from all patients. The progression of hip collapse was assessed by the method of modified Nish Ⅱ and the radiographic progression rate was calculated at the last follow-up. Data were processed with Wilcoxon signed-rank test, Mann Whitney U test and chi-square test.

Results

The mean follow-up time was (117.1±4.1) months after porous tantalum rod implantation. and the hip preservation rates at 24, 60 and 96 months after surgery were 92.5%(37/40), 82.5%(33/40) and 75%(30/40), respectively. At 24, 60 months after surgery, there were no statistically significant differences in hip preservation rates between ARCO Ⅱ patients and ARCO Ⅲ patients (χ2=0.001, 1.396; P=1.000, 0.457). At 96 months after surgery, the hip preservation rate of ARCO Ⅱ patients [89.6% (23/27)] was higher than that of ARCO Ⅲ patients [53.8% (7/13)], the difference was statistically significant (χ2=4.596, P=0.042). At 24 and 60 months after surgery, there were no statistically significant differences in hip preservation rates between JIC C1 patients and JIC C2 patients (χ2=0.041, 0.145; P=0.839, 0.703). At 96 months after surgery, the hip preservation rate of JIC C1 patients [83.3% (25/30)] was higher than that of JIC C2 patients [50.0% (5/10)], the difference was statistically significant (χ2=4.444, P=0.035). Before receiving porous tantalum rod implantation, the Harris hip score of ONFH patients was 59 (55, 61) points, and the Harris hip scores of ONFH patients were 72(61, 80), 89 (82, 91), and 94(91, 96) points at 24, 60, and 96 months after surgery, respectively, the difference was statistically significant (Z=4.627, P<0.05). There were no statistically significant differences in Harris hip scores between ARCO Ⅱ patients and ARCO Ⅲ patients before surgery, 60 and 96 months after surgery (Z=123.5, 180.0, 101.0; P=0.114, 0.994, 0.871). At 24 months after surgery, there were no statistically significant differences in Harris hip scores between between ARCO Ⅱ patients and ARCO Ⅲ patients (Z=100.0, P=0.043). Before and 96 months after surgery, there were no statistically significant differences in Harris hip scores between JIC C1 patients and JIC C2 patients (Z=164.0, 90.0; P=0.279, 0.355). At 24 and 60 months after surgery, there were statistically significant differences in Harris hip score between JIC C1 patients and JIC C2 patients (Z=96.5, 93.0, P=0.042, 0.038). The overall radiographic progression rate at the last follow-up was 55.0%(22/40). The imaging progression rate of ARCO Ⅱ patients was 48.1%(13/27), compared with ARCO Ⅲ patients [69.2%(9/13)], there was no statistically significant difference (χ2=1.255, P=0.391). The imaging progression rate of JIC C1 patients was 46.7% (14/30), compared with JIC C2 patients [80%(8/10)], there was no statistically significant difference (χ2=1.835, P=0.086). There was statistically significant difference in hip preservation rates between ARCO Ⅲ patients with radiographic progression[11.1%(1/9)] and ARCO Ⅱ patients with radiographic progression[76.9% (10/13)](χ2=3.035, P=0.024). The hip preservation rate of JIC C2 patients with radiographic progression [12.5% (1/8)] was significantly different from that of JIC C1 patients with radiographic progression [71.4% (10/14)](χ2=2.659, P=0.009). There were statistically significant differences in Harris hip scores in the second surgery group and the control group before THA and 60 months after THA (Z=6.511, 7.471; P<0.05). At 60 months after surgery, the Harris hip score of the second surgery group and the control group was 88 (85, 93) points and 94 (92, 96), respectively, there was no statistically significant difference (Z=0.044, P=0.090).

Conclusions

In the medium-long term follow-up, porous tantalum rod implantation in the treatment of ONFH has a high hip preservation rate in ARCO Ⅱ and JIC C1 patients, while the effect of ARCO Ⅲ or JIC C2 patients is not so good. The key to the application of this technology is to select the appropriate patients. Patients with advanced ONFH who underwent THA and patients who underwent THA after porous tantalum rod implantation failed has similar clinical outcomes.

Key words: Femur head necrosis, Arthroplasty, replacement, hip, Porous tantalum rod implantation, Harris hip score
表1 2组行THA的ONFH患者一般资料比较
组别 例数 性别(例) 平均年龄(岁，±s) 随访时间(个月，±s) 病因(例) JIC分型(例)
男 女 酒精性 激素性 原发性 C1型 C2型
二次手术组 12 8 4 44.0±10.0 78.9±31.7 3 8 1 6 6
对照组 57 32 25 42.7±13.7 87.4±14.9 13 27 17 18 39
χ2值   1.429     1.385 1.218
t值     0.311 1.429    
P值   0.749 0.757 0.158 0.500 0.318
表2 不同分期的ONFH患者多孔钽棒植入术术后不同时相点保髋率比较[例(%)]
分期 髋数 术后24个月 术后60个月 术后96个月
ARCO Ⅱ期 27 25(92.6) 23(88.9) 23(88.9)
ARCO Ⅲ期 13 12(92.6) 9(69.2) 7(53.8)
χ2值   0.001 1.396 4.596
P值   1.000 0.457 0.042
表3 不同分型的ONFH患者多孔钽棒植入术术后不同时相点保髋率比较[例(%)]
分型 髋数 术后24个月 术后60个月 术后96个月
JIC C1型 30 27(90.0) 26(86.7) 25(83.3)
JIC C2型 10 10(100.0) 7(70.0) 5(50.0)
χ2值   0.041 0.145 4.444
P值   0.839 0.703 0.035
表4 不同分期的ONFH患者接受多孔钽棒植入术术后不同时相点Harris髋关节评分的比较[分， M(Q1，Q3)]
分期 髋数 术前 术后24个月 术后60个月 术后96个月
ARCO Ⅱ期 27 59(56，61) 61(55，63) 89(88，91) 94(90，96)
ARCO Ⅲ期 13 53(46，56) 79(68，84) 90(78，91) 92(90，95)
Z值   123.5 100.0 180.0 101.0
P值   0.114 0.043 0.994 0.871
表5 不同分型的ONFH患者接受多孔钽棒植入术术后不同时相点Harris髋关节评分的比较[分， M(Q1，Q3)]
分型 髋数 术前 术后24个月 术后60个月 术后96个月
JIC C1型 30 57(52，61) 86(82，90) 90(87，91) 94(91，96)
JIC C2型 10 61(55，63) 68(61，83) 82(65，88) 89(70，94)
Z值   164.0 96.5 93.0 90.0
P值   0.279 0.042 0.038 0.355
表6 2组ONFH患者THA术前、术后60个月Harris髋关节评分比较[分， M(Q1，Q3)]
组别 髋数 术前 术后60个月 Z值 P值
二次手术组 12 56(50，59) 88(85，93) 6.511 <0.05
对照组 57 62(54，67) 94(92，96) 7.471 <0.05
Z值   -0.697 -1.711    
P值   0.486 0.090    
图1 右侧酒精性ONFH患者多孔钽棒植入术术前右髋关节X线、MRI检查与术后右髋关节X线检查。A示术前正位X线检查，可见骨坏死区及硬化带(红色箭头)，关节面无塌陷，关节间隙正常；坏死病灶超出负重区2/3，但界限在髋臼内；B示术前蛙位X线检查，可见骨坏死区及硬化带(红色箭头)，未见前方负重区关节面塌陷；C示术前冠状位MRI检查(T1加权)，股骨头负重区可见局限性混杂低信号区(黄色箭头)；D示术前股骨颈轴位MRI检查(T1加权)，可见股骨头内局限性低信号区从前方向后方不规则延伸(黄色箭头)，局部信号混杂；E示术后3 d，正位X线检查可见多孔钽棒在位，股骨头形态无明显变化，关节面无塌陷；F示术后3 d，蛙位X线检查可见多孔钽棒在位，前方负重区关节面无塌陷；G示术后108个月，正位X线复查可见多孔钽棒在位，坏死区边缘可见部分高密度骨修复(白色箭头)，关节面出现轻度塌陷(蓝色箭头)，但髋臼匹配仍存在，关节间隙存在；H示术后108个月，蛙位X线复查，可见多孔钽棒在位，前方负重面出现轻度塌陷(蓝色箭头)，关节间隙存在；ONFH为股骨头坏死
[1]
Osawa Y, Seki T, Takegami Y, et al. Do femoral head collapse and the contralateral condition affect patient-reported quality of life and referral pain in patients with osteonecrosis of the femoral head[J]. Int Orthop, 2018, 42(7): 1463-1468.
[2]
Zhu S, Zhang X, Chen X, et al. Comparison of cell therapy and other novel adjunctive therapies combined with core decompression for the treatment of osteonecrosis of the femoral head: a systematic review and meta-analysis of 20 studies[J]. Bone Joint Res, 2021, 10(7): 445-458.
[3]
Pepke W, Kasten P, Beckmann NA, et al. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis: a randomized prospective study[J]. Orthop Rev, 2016, 8(1): 6162.
[4]
魏秋实，庞凤祥，陈哓俊，等. 经髋关节外科脱位打压植骨支撑术治疗ARCOⅢ期股骨头坏死的临床疗效分析[J/CD]. 中华损伤与修复杂志(电子版), 2020, 15(2): 90-95.
[5]
Larson E, Jones LC, Goodman SB, et al. Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018[J]. Int Orthop, 2018, 42(7): 1723-1728.
[6]
Kawano K, Motomura G, Ikemura S, et al. Long-term hip survival and factors influencing patient-reported outcomes after transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head: A minimum 10-year follow-up case series[J]. Mod Rheumatol, 2020, 30(1): 184-190.
[7]
Moon JK, Yoon JY, Kim CH, et al. Multiple drilling and multiple matchstick-like bone allografts for large osteonecrotic lesions in the femoral head: an average 3-year follow-up study[J]. Arch Orthop Trauma Surg, 2020, 140(11): 1655-1663.
[8]
Gagala J, Tarczynska M, Gaweda K. Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report[J]. Int Orthop, 2013, 37(7): 1239-1244.
[9]
Han J, Gao F, Li Y, et al. The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review[J]. Biomed Res Int, 2020, 2020: 2642439.
[10]
孙伟，刘立华，高福强，等. 髓芯减压联合自体骨髓单核细胞移植治疗股骨头坏死失败病例分析[J/CD]. 中华损伤与修复杂志(电子版), 2020, 15(2): 110-114.
[11]
黄润华，尚希福，胡飞，等. 多孔钽杯及钽金属垫块在PaproskyⅢ、Ⅳ型髋臼缺损翻修中的应用研究[J]. 中华骨与关节外科杂志， 2016, 9(5): 386-389, 393.
[12]
汪亮，刘耀升，刘蜀彬，等. 多孔钽棒植入治疗早中期股骨头坏死的生存率分析和预后因素评估[J]. 中华骨与关节外科杂志， 2015, 8(5): 396-402.
[13]
Nadeau M, Seguin C, Theodoropoulos JS, et al. Short term clinical outcome of a porous tantalum implant for the treatment of advanced osteonecrosis of the femoral head[J]. McGill J Med, 2007, 10(1): 4-10.
[14]
Auregan JC, Villain B, Begue T. What is the rate of patients undergoing a total hip arthroplasty after core decompression and insertion of a tantalum rod in osteonecrosis of the femoral head: a systematic review[J]. Int Orthop, 2018, 42(7): 1631-1638.
[15]
Olsen M, Lewis PM, Morrison Z, et al.Total hip arthroplasty following failure of core decompression and tantalum rod implantation[J]. Bone Joint J, 2016, 98-B(9): 1175-1179.
[16]
Varitimidis SE, Dimitroulias AP, Karachalios TS, et al. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years[J]. Acta Orthop, 2009, 80(1): 20-25.
[17]
Davis ET, McKee MD, Waddell JP, et al. Total hip arthroplasty following failure of free vascularized fibular graft[J]. J Bone Joint Surg Am, 2006, 88 Suppl 3: 110-115.
[18]
Nishii T, Sugano N, Ohzono K, et al. Progression and cessation of collapse in osteonecrosis of the femoral head[J]. Clin Orthop Relat Res, 2002(400): 149-157.
[19]
Ma J, Sun W, Gao F, et al. Porous tantalum implant in treating osteonecrosis of the femoral head: still a viable option[J]. Sci Rep, 2016, 6: 28227.
[20]
Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant[J]. Int Orthop, 2011, 35(4): 489-495.
[21]
Liu G, Wang J, Yang S, et al. Effect of a porous tantalum rod on early and intermediate stages of necrosis of the femoral head[J]. Biomed Mater, 2010, 5(6): 065003.
[22]
Tsao AK, Roberson JR, Christie MJ, et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis[J]. J Bone Joint Surg Am, 2005, 87 Suppl 2: 22-27.
[23]
Liu B, Sun W, Yue D, et al. Combined tantalum implant with bone grafting for the treatment of osteonecrosis of the femoral head[J]. J Invest Surg, 2013, 26(3): 158-162.
[24]
Hu R, Lei P, Li B, et al. Real-time computerized tomography assisted porous tantalum implant in ARCO stage Ⅰ-Ⅱ non-traumatic osteonecrosis of the femoral head: minimum five-year follow up[J]. Int Orthop, 2018, 42(7): 1535-1544.
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