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目的 探讨髓芯减压后多孔钽棒联合富血小板血浆植入（platelet‐rich plasma，PRP）治疗早期股骨头坏死的临床效果。 方法 根据纳入与排除标准，纳入2017年1月至2020年12月首都医科大学附属北京康复医院骨科和山东大学齐鲁医院德州医院骨科收治的早期股骨头坏死患者120例，随机分成单纯钽棒组、PRP联合钽棒组，2组患者均进行髓芯减压手术，比较2组患者手术时间、术后平均住院时间、术前及术后不同时间点视觉模拟（visual analogue scale，VAS）评分、髋关节Harris评分情况及术后并发症发生情况。 结果 两组患者手术时间、术后平均住院日及术后并发症发生率比较，差异无统计学意义（P > 0.05）。两组患者术前VAS评分比较，差异无统计学意义，术后1周时PRP联合钽棒组患者疼痛评分较单纯钽棒组增高，差异有统计学意义（P < 0.05）；随时间增长，PRP联合钽棒组患者VAS评分较单纯钽棒组降低，差异有统计学意义（P < 0.05）。两组患者术后髋关节Harris评分均较术前增加，且PRP联合钽棒组评分高于单纯钽棒组，差异有统计学意义（P < 0.05）。2组患者并发症发生率差异无统计学意义（P > 0.05）。 结论 对于早期股骨头坏死患者，髓芯减压后联合钽棒+PRP植入，可以减轻患者髋关节疼痛症状，促进患者髋关节功能恢复。
","endNoteUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=EndNote&id=347","reference":"| 1 | 左荣台， 关俊杰， 康庆林. 激素性股骨头坏死治疗研究进展［J］. 国际骨科学杂志， 2019， 40（3）： 160. |
| 2 | Zhao DW， Yu M， Hu K， et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population： results from a nationally representative survey［J］. Chin Med J （Engl）， 2015， 128（21）： 2843. |
| 3 | 赵德伟， 杨磊， 田丰德， 等. 大连市潜水员股骨头坏死发病率的流行病学调查报告［J］. 中华骨科杂志， 2012， 32（6）： 521. |
| 4 | 张长青. 股骨头坏死保髋治疗指南（2016版）［J］. 中华老年骨科与康复电子杂志， 2016， 2（2）： 65. |
| 5 | Warner JJ， Philip JH， Brodsky GL， et al. Studies of nontraumatic osteonecrosis. The role of core decompression in the treatment of nontraumatic osteonecrosis of the femoral head［J］. Clin Orthop Relat Res， 1987（225）： 104. |
| 6 | 李艳兵， 刘文斌. 髓芯减压多孔钽棒联合自体骨移植治疗FicatⅡ期股骨头坏死的疗效［J］. 实用骨科杂志， 2019， 25（11）： 1027. |
| 7 | 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 ：22. |
| 8 | Karakaplan M， Gülabi D， Topgül H， et al. Does platelet-rich plasma have a favorable effect in the early stages of steroid-associated femoral head osteonecrosis in a rabbit model？［J］. Eklem Hastalik Cerrahisi， 2017， 28（2）： 107. |
| 9 | Sugaya H， Yoshioka T， Kato T， et al. Comparative analysis of cellular and growth factor composition in bone marrow aspirate concentrate and platelet-rich plasma［J］. Bone Marrow Res， 2018， 2018： 1549826. |
| 10 | Zhang Y， Li L， Shi ZJ， et al. Porous Tantalum rod implant is an effective and safe choice for early-stage femoral head necrosis： a meta-analysis of clinical trials［J］. Eur J Orthop Surg Traumatol， 2013， 23（2）： 211. |
| 11 | Bobyn JD， Stackpool GJ， Hacking SA， et al. Characteristics of bone ingrowth and interface mechanics of a new porous Tantalum biomaterial［J］. J Bone Joint Surg Br， 1999， 81（5）： 907. |
| 12 | Ma JH， Sun W， Gao FQ， et al. Porous Tantalum implant in treating osteonecrosis of the femoral head： still a viable option？［J］. Sci Rep， 2016， 6（1）： 28227. |
| 13 | Sultan AA， Mohamed N， Samuel LT， et al. Classification systems of hip osteonecrosis： an updated review［J］. Int Orthop， 2019， 43（5）： 1089. |
| 14 | Bohndorf K， Roth A. ［Imaging and classification of avascular femoral head necrosis］［J］. Orthopade， 2018， 47（9）： 729. |
| 15 | 吴晓斌， 郭静， 刘朝阳， 等. 富血小板血浆联合同种异体骨移植治疗早期股骨头坏死［J］. 中国骨科临床与基础研究杂志， 2017， 9（4）： 218. |
| 16 | 梁凡. 小直径多孔道髓芯减压术治疗早期股骨头坏死的临床研究［D］. 武汉： 武汉大学， 2018： 83. |
| 17 | 胡捷斯， 杨继梅， 鲁晓波， 等. 股骨头缺血性坏死患者髋关节X线检查相关参数与Harris评分的关系［J］. 山东医药， 2018， 58（20）： 75. |
| 18 | 毛小成， 赵枫. 髓芯减压金属钽棒植入治疗早期股骨头坏死［J］. 临床军医杂志， 2012， 40（6）： 1525. |
| 19 | Mont MA， Hungerford DS. Non-traumatic avascular necrosis of the femoral head［J］. J Bone Joint Surg Am， 1995， 77（3）： 459. |
| 20 | 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. |
| 21 | Veillette CJH， Mehdian H， Schemitsch EH， et al. Survivorship analysis and radiographic outcome following Tantalum rod insertion for osteonecrosis of the femoral head［J］. J Bone Joint Surg Am， 2006， 88 ：48. |
| 22 | 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. |
| 23 | 许伟华， 杨述华， 冯勇， 等. 多孔钽棒植入治疗股骨头坏死的适应证及临床疗效观察［J］. 中国骨与关节外科， 2010， 3（1）： 28. |
| 24 | 杨富强， 杨晓明， 葛建健， 等. 髓芯减压植骨联合富血小板血浆治疗股骨头缺血性坏死的前瞻随机对照研究［J］. 中华关节外科杂志（电子版）， 2016， 10（2）： 22. |
| 25 | 刘江锋. 髓芯减压联合自体骨髓间充质干细胞移植治疗股骨头坏死［J］. 中国组织工程研究， 2019， 23（29）： 4599. |
| 26 | 胡钟旭， 李东卿， 李贵涛， 等. 富血小板血浆联合骨髓间充质干细胞治疗家兔股骨头缺血坏死的研究［J］. 中华损伤与修复杂志（电子版）， 2014， 9（1）： 22. |
| 27 | 姜良斌， 刘松， 岳永彬， 等. 富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究［J］. 中国临床解剖学杂志， 2018， 36（1）： 93. |
| 28 | 吴晓斌， 刘朝阳. 股骨头坏死手术治疗及其自体PRP在保髋手术中的应用进展［J］. 中国骨科临床与基础研究杂志， 2017， 9（3）： 186. |
| 29 | 陈彦同， 周明旺， 李盛华， 等. 外泌体与非创伤性股骨头坏死的相关性研究进展［J］. 中国矫形外科杂志， 2019， 27（5）： 439. |
), 宋兵2, 解焕鑫1, 章耀华1, 张鸿悦1, 杨华清1()","risUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=Ris&id=347","title_cn":"髓芯减压后多孔钽棒联合富血小板血浆植入治疗早期股骨头坏死","doi":"10.3969/j.issn.2097-0005.2022.08.004","jieShuYe":"579","keywordList_en":["osteonecrosis of femoral head","lschemic necrosis","tantalum rod","platelet rich plasma","core decompression"],"endNoteUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=EndNote&id=347","zhaiyao_en":"Objective To explore the clinical effect of porous tantalum bar combined with PRP in the treatment of early necrosis of femoral head. Methods According to the into and exclusion criteria， included 120 patients， randomly divided into pure tantalum rod group， PRP combined tantalum rods， perfect perioperative examination， 2 patients respectively for pulp core decompression treatment and postoperative routine perioperative management， record and compare the two groups patients average operation time， postoperative hospital stay， postoperative pain score； Harris score of hip joint before operation， 1 month， 3 months， 6 months and 12 months after operation in 2 groups； Postoperative complications occurred in 2 groups. Results There was no significant difference in operation time between the two groups. The patients in the tantalum bar group were （4.15 ± 2.19） d and the patients in the PRP combined group were （4.12 ± 2.23） d. There was no statistically significant difference in the length of hospital stay between the patients in the pure tantalum bar group and the patients in the PRP combined with tantalum bar core decompression （P > 0.05）. There was no statistically significant difference in preoperative VAS score between the two groups. One week after surgery， pain score of patients with PRP combined with tantalum rods was significantly higher than that of patients with tantalum rods alone； With the increase of time， VAS scores of patients with PRP combined with tantalum rods gradually decreased， which was significantly lower than that of patients with tantalum rods alone. Postoperative Harris score of the hip joint was significantly increased in both groups compared with that before surgery， and PRP combined with tantalum rod core decompression significantly improved Harris function of the hip joint compared with that of tantalum rod core alone， and the difference was statistically significant.There was no statistically significant difference in complications between the two groups. Conclusion For patients with early necrosis of the femoral head， medullary core decompression combined with tantalum rod + PRP implantation can achieve good surgical results， reduce the symptoms of the hip joint and promote the recovery of the function of the hip joint， but further clinical studies are needed.
","bibtexUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=BibTeX&id=347","abstractUrl_cn":"http://xuebao.sdfmu.edu.cn/CN/10.3969/j.issn.2097-0005.2022.08.004","zuoZheCn_L":"郭峰, 宋兵, 解焕鑫, 章耀华, 张鸿悦, 杨华清","juanUrl_cn":"http://xuebao.sdfmu.edu.cn/CN/Y2022","lanMu_en":"Clinical Researches","qiUrl_en":"//www.pitakata.com/xuebao/EN/Y2022/V43/I8","zuoZhe_EN":"Feng GUO1(), Bing SONG2, Huanxin XIE1, Yaohua ZHANG1, Hongyue ZHANG1, Huaqing YANG1()","risUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=Ris&id=347","title_en":"Clinical study on treatment of early necrosis of femoral head with porous tantalum rod and Platelet-rich plasma implantation after core decompression","hasPdf":"true"},"authorNotes_cn":["郭峰，硕士，副主任医师，研究方向：运动功能康复， E-mail：logosgf@163.com。","杨华清，博士，主任医师，研究方向：下肢畸形矫形， E-mail：gkgf100@sina.com。
Clinical study on treatment of early necrosis of femoral head with porous tantalum rod and Platelet-rich plasma implantation after core decompression
Feng GUO, Bing SONG, Huanxin XIE, Yaohua ZHANG, Hongyue ZHANG, Huaqing YANG
Journal of ShanDong First Medical University&ShanDong Academy of Medical Sciences››2022, Vol. 43››Issue (8): 575-579.
PDF(659 KB)
PDF(659 KB)
Clinical study on treatment of early necrosis of femoral head with porous tantalum rod and Platelet-rich plasma implantation after core decompression
ObjectiveTo explore the clinical effect of porous tantalum bar combined with PRP in the treatment of early necrosis of femoral head.MethodsAccording to the into and exclusion criteria， included 120 patients， randomly divided into pure tantalum rod group， PRP combined tantalum rods， perfect perioperative examination， 2 patients respectively for pulp core decompression treatment and postoperative routine perioperative management， record and compare the two groups patients average operation time， postoperative hospital stay， postoperative pain score； Harris score of hip joint before operation， 1 month， 3 months， 6 months and 12 months after operation in 2 groups； Postoperative complications occurred in 2 groups.ResultsThere was no significant difference in operation time between the two groups. The patients in the tantalum bar group were （4.15 ± 2.19） d and the patients in the PRP combined group were （4.12 ± 2.23） d. There was no statistically significant difference in the length of hospital stay between the patients in the pure tantalum bar group and the patients in the PRP combined with tantalum bar core decompression （P> 0.05）. There was no statistically significant difference in preoperative VAS score between the two groups. One week after surgery， pain score of patients with PRP combined with tantalum rods was significantly higher than that of patients with tantalum rods alone； With the increase of time， VAS scores of patients with PRP combined with tantalum rods gradually decreased， which was significantly lower than that of patients with tantalum rods alone. Postoperative Harris score of the hip joint was significantly increased in both groups compared with that before surgery， and PRP combined with tantalum rod core decompression significantly improved Harris function of the hip joint compared with that of tantalum rod core alone， and the difference was statistically significant.There was no statistically significant difference in complications between the two groups.ConclusionFor patients with early necrosis of the femoral head， medullary core decompression combined with tantalum rod + PRP implantation can achieve good surgical results， reduce the symptoms of the hip joint and promote the recovery of the function of the hip joint， but further clinical studies are needed.
osteonecrosis of femoral head/lschemic necrosis/tantalum rod/platelet rich plasma/core decompression
| 1 | 左荣台， 关俊杰， 康庆林. 激素性股骨头坏死治疗研究进展［J］. 国际骨科学杂志， 2019， 40（3）： 160. |
| 2 | Zhao DW， Yu M， Hu K， et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population： results from a nationally representative survey［J］. Chin Med J （Engl）， 2015， 128（21）： 2843. |
| 3 | 赵德伟， 杨磊， 田丰德， 等. 大连市潜水员股骨头坏死发病率的流行病学调查报告［J］. 中华骨科杂志， 2012， 32（6）： 521. |
| 4 | 张长青. 股骨头坏死保髋治疗指南（2016版）［J］. 中华老年骨科与康复电子杂志， 2016， 2（2）： 65. |
| 5 | Warner JJ， Philip JH， Brodsky GL， et al. Studies of nontraumatic osteonecrosis. The role of core decompression in the treatment of nontraumatic osteonecrosis of the femoral head［J］. Clin Orthop Relat Res， 1987（225）： 104. |
| 6 | 李艳兵， 刘文斌. 髓芯减压多孔钽棒联合自体骨移植治疗FicatⅡ期股骨头坏死的疗效［J］. 实用骨科杂志， 2019， 25（11）： 1027. |
| 7 | 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 ：22. |
| 8 | Karakaplan M， Gülabi D， Topgül H， et al. Does platelet-rich plasma have a favorable effect in the early stages of steroid-associated femoral head osteonecrosis in a rabbit model？［J］. Eklem Hastalik Cerrahisi， 2017， 28（2）： 107. |
| 9 | Sugaya H， Yoshioka T， Kato T， et al. Comparative analysis of cellular and growth factor composition in bone marrow aspirate concentrate and platelet-rich plasma［J］. Bone Marrow Res， 2018， 2018： 1549826. |
| 10 | Zhang Y， Li L， Shi ZJ， et al. Porous Tantalum rod implant is an effective and safe choice for early-stage femoral head necrosis： a meta-analysis of clinical trials［J］. Eur J Orthop Surg Traumatol， 2013， 23（2）： 211. |
| 11 | Bobyn JD， Stackpool GJ， Hacking SA， et al. Characteristics of bone ingrowth and interface mechanics of a new porous Tantalum biomaterial［J］. J Bone Joint Surg Br， 1999， 81（5）： 907. |
| 12 | Ma JH， Sun W， Gao FQ， et al. Porous Tantalum implant in treating osteonecrosis of the femoral head： still a viable option？［J］. Sci Rep， 2016， 6（1）： 28227. |
| 13 | Sultan AA， Mohamed N， Samuel LT， et al. Classification systems of hip osteonecrosis： an updated review［J］. Int Orthop， 2019， 43（5）： 1089. |
| 14 | Bohndorf K， Roth A. ［Imaging and classification of avascular femoral head necrosis］［J］. Orthopade， 2018， 47（9）： 729. |
| 15 | 吴晓斌， 郭静， 刘朝阳， 等. 富血小板血浆联合同种异体骨移植治疗早期股骨头坏死［J］. 中国骨科临床与基础研究杂志， 2017， 9（4）： 218. |
| 16 | 梁凡. 小直径多孔道髓芯减压术治疗早期股骨头坏死的临床研究［D］. 武汉： 武汉大学， 2018： 83. |
| 17 | 胡捷斯， 杨继梅， 鲁晓波， 等. 股骨头缺血性坏死患者髋关节X线检查相关参数与Harris评分的关系［J］. 山东医药， 2018， 58（20）： 75. |
| 18 | 毛小成， 赵枫. 髓芯减压金属钽棒植入治疗早期股骨头坏死［J］. 临床军医杂志， 2012， 40（6）： 1525. |
| 19 | Mont MA， Hungerford DS. Non-traumatic avascular necrosis of the femoral head［J］. J Bone Joint Surg Am， 1995， 77（3）： 459. |
| 20 | 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. |
| 21 | Veillette CJH， Mehdian H， Schemitsch EH， et al. Survivorship analysis and radiographic outcome following Tantalum rod insertion for osteonecrosis of the femoral head［J］. J Bone Joint Surg Am， 2006， 88 ：48. |
| 22 | 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. |
| 23 | 许伟华， 杨述华， 冯勇， 等. 多孔钽棒植入治疗股骨头坏死的适应证及临床疗效观察［J］. 中国骨与关节外科， 2010， 3（1）： 28. |
| 24 | 杨富强， 杨晓明， 葛建健， 等. 髓芯减压植骨联合富血小板血浆治疗股骨头缺血性坏死的前瞻随机对照研究［J］. 中华关节外科杂志（电子版）， 2016， 10（2）： 22. |
| 25 | 刘江锋. 髓芯减压联合自体骨髓间充质干细胞移植治疗股骨头坏死［J］. 中国组织工程研究， 2019， 23（29）： 4599. |
| 26 | 胡钟旭， 李东卿， 李贵涛， 等. 富血小板血浆联合骨髓间充质干细胞治疗家兔股骨头缺血坏死的研究［J］. 中华损伤与修复杂志（电子版）， 2014， 9（1）： 22. |
| 27 | 姜良斌， 刘松， 岳永彬， 等. 富血小板血浆联合钻孔减压、同种异体腓骨支撑治疗早期股骨头坏死的研究［J］. 中国临床解剖学杂志， 2018， 36（1）： 93. |
| 28 | 吴晓斌， 刘朝阳. 股骨头坏死手术治疗及其自体PRP在保髋手术中的应用进展［J］. 中国骨科临床与基础研究杂志， 2017， 9（3）： 186. |
| 29 | 陈彦同， 周明旺， 李盛华， 等. 外泌体与非创伤性股骨头坏死的相关性研究进展［J］. 中国矫形外科杂志， 2019， 27（5）： 439. |
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