定制型人工髋关节置换治疗股骨近端瘤性病变  

TREATMENT OF TUMOROUS DISEASE IN PROXIMAL FEMUR BY CUSTOMIZED HIP ARTHROPLASTY

作　　者：郭炜[1] 李荣文[1] 徐光辉[1] 苏涛[1] 徐东潭[1] 李庆涛[1] 

机构地区：[1]淄博市中心医院骨科,山东淄博255036

出　　处：《中国修复重建外科杂志》2006年第10期989-991,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨定制型人工髋关节置换治疗股骨近端瘤性病变的经验及临床效果。方法1994年2月～2002年11月，对11例股骨近端瘤性病变行股骨近端切除、带部分股骨假体的人工髋关节置换术。男7例，女4例。年龄40～69岁。左侧9例，右侧2例。其中股骨近端骨巨细胞瘤7例，软骨母细胞瘤2例，畸形性骨炎1例，骨纤维异常增殖症1例。行人工全髋关节置换6例，双极杯人工股骨头置换5例。结果术后9例获随访1～5年，2例失访。1例术后创面渗血、股部近端连续加压包扎5d后股四头肌功能丧失，股前部感觉消失；术后5年随访股四头肌肌力0级，股前部感觉减退，胭绳肌及小腿伸屈肌群肌力3级，跛行，需扶拐行走。5例股四头肌肌力3级，其中2例感觉股部近端阵发性疼痛，尤以久站及行走后疼痛明显，均为双极杯股骨头假体置换者；3例股四头肌力4级。8例髋关节外展10～27°，髋关节屈曲，平均74°。采用Harris标准评定，良（80～89分）3例，中（70～79分）5例，差（70分以下）1例。术后无感染，随访期间无肿瘤复发及假体松动。结论定制型人工髋关节置换治疗股骨近端瘤性病变是一种有效方法，但术后股四头肌无力发生率较高，与股四头肌上部附着处丢失有关。术中将股四头肌，特别是其附着的内、外、后肌间隔贯穿固定于假体体部，可望有效改善股四头肌肌力。Objective To summarize and analyze the clinical experience and the clinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. Methods Eleven patients （7 males and 4 females, aged 40-69 years） with a tumorous disease in the proximal femur received a removal of the proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. Results The follow-up for 1-5 years in 9 patients （2 patients lost the follow-up） revealed that after operation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the ＂0＂ degree, a decreased sensation, the ＂3＂ degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle power test showed that 5 patients had the ＂3＂ degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the ＂4＂ degree of the quadriceps muscle power, with an extension range of the hip joint of 10°-27° and an average flexion degree of 74° According to the Harris scale, 3 patients were assessed to be good （80-89）, 5 moderate （70-79）, but 1 bad （〈70）. No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. Conclusion The customized hip arthroplasty has a good clinical outcome in treatment of a tum

关 键 词：人工髋关节置换 骨肿瘤 保肢 

分 类 号：R738.1[医药卫生—肿瘤] R318.08[医药卫生—临床医学]