多孔钽金属棒治疗早期股骨头无菌性坏死：应用与问题

摘要

背景：临床上股骨头无菌性坏死的治疗方案都具有各自的优势和局限性，早期诊断、早期治疗已成为共识，如何保留患者的股骨头也一直是临床治疗的核心。　　目的：综述目前国内外对股骨头无菌性坏死的治疗现状，主要分析多孔钽金属棒治疗早期股骨头无菌性坏死的研究进展。　　方法：由第一作者检索1985年1月至2013年8月的 PubMed 数据库，在标题和中以“avascular necrosis”，“osteonecrosis of the femoral head”和“tantalum rod”为主题词检索有关股骨头无菌性坏死发病机制、风险因素、分型及治疗等方面的相关文献。排除与研究目的相关性差以及内容重复的文献，最后选择42篇进行归纳总结。　　结果与结论：治疗股骨头无菌性坏死的关键在于早期诊断和早期干预。髓芯减压+多孔钽金属棒置入是一项治疗股骨头尚未塌陷的早期股骨头无菌性坏死的微创技术，能延缓或防止早期股骨头坏死进一步发展，但对于出现股骨头塌陷、继发性髋关节骨关节炎的晚期患者效果较差。虽然多孔钽金属棒置入在临床已开始应用，有些报道也显示出令人振奋的短期疗效，但其在临床治疗经济学方面的效果仍需要通过多中心、随机、双盲对照研究来权衡。%BACKGROUND:Each clinical treatment option for avascular necrosis of the femoral head has its own advantages and disadvantages, but early diagnosis and early treatment are firmly rooted in most of orthopedic doctors, and the purpose of treatment is focused on how to preserve the femoral head and how to maintain the hip function. OBJECTIVE:To summarize the current opinions and studies concerning the treatment of avascular necrosis of the femoral head, including core decompression and porous tantalum rod implantation, and to elucidate the clinical results and cost-effectiveness of the use of porous tantalum rod. METHODS:The PubMed database was searched by the first author for the articles on the aspect of pathogenesis, risk factors, disease staging and treatment options of avascular necrosis of the femoral head from January 1985 to August 2013 with the key words of“avascular necrosis”,“osteonecrosis of the femoral head”and “tantalum rod”in titles or abstracts. Literatures exhibiting poor correlation with the research purpose and duplicate literature were excluded, and final y, 42 articles were included in result analysis. RESULTS AND CONCLUSION:The key point of treating avascular necrosis of the femoral head depends on early diagnosis and early intervention. Core decompression plus porous tantalum rod implantation is a minimal y invasive technique in treating early-stage avascular necrosis of the femoral head, in which the subchondral fracture and the femoral head col apse do not occur. If core decompression and porous tantalum rod implantation is used properly, this option does delay or prevent the progress of avascular necrosis of the femoral head. But, if avascular necrosis of the femoral head is in late stage, which means that subchondral fracture and the femoral head col apse occur, the clinical results of this option are poor. Although porous tantalum rod implantation in the treatment of early-stage avascular necrosis of the femoral head demonstrates good exciting short-term results, the clinical value of its long-term results and cost-effectiveness should be elucidated in multicentre, double-blinded, randomized, control ed trials in the future.