BetaCone双锥度生物固定型髋关节柄在严重骨质疏松全髋关节置换中的早期应用  

Early application of BetaCone double-tapered stem shape prosthesis in total hip arthropasty following severe osteoporosis

作　　者：贾世孔[1] 肖晟[1] 张寅龙[1] 

机构地区：[1]天津市人民医院,天津市300121

出　　处：《中国组织工程研究与临床康复》2008年第30期5801-5804,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:全髋关节置换股骨部分采用非骨水泥固定已成为国际流行的趋势,但临床上许多诸如高龄、绝经、强直性脊柱炎等情形导致发生严重骨质疏松的患者,其选用生物固定柄的股骨柄效果仍有待大宗病历证实。目的:总结使用BetaCone双锥度生物固定型髋关节柄在严重骨质疏松患者全髋关节置换中的应用效果。设计、时间及地点:回顾性病例分析,于2006-10/2008-01在天津市人民医院完成。对象:选取同期天津市人民医院收治的行人工全髋关节置换的11例严重骨质疏松患者(11髋),强直性脊柱炎4例,髋关节置换后无菌性松动5例,股骨颈骨折2例,其中强直性脊柱炎2例虽为双侧患病,但考虑到患者身体状况仅行单侧置换。BetaCone双锥度生物固定型髋关节柄假体为德国LINK公司产品。方法:11例患者全髋关节置换均采用常规后外侧入路,强直性脊柱炎患者融合髋手术先行股骨颈楔形截骨以获得较好的显露。在髋臼假体安装完成后,股骨髓腔近端开口,保持正确的前倾角打入髓腔锉,选用与扩髓锉同号的假体安装复位。置换前后使用Harris评分系统进行功能评定。常规摄髋关节正侧位X射线片,了解假体与骨界面是否有透光区和硬化带,观察假体是否有移位发生以及假体与股骨的接触情况、假体固定的稳定性。主要观察指标:全髋关节置换效果,置换后并发症。结果:11例骨质疏松患者均获得完整随访,目前平均随访8.7个月。由于本病例分析是早期报道,故取4例随访时间达6个月的患者病历进行结果分析。Harris评分由置换前的平均47.3分上升到置换后的83.2分,优良率90.1%,最近一次随访X射线片评价假体在位良好,无松动、下沉现象,关节功能恢复情况满意。1例翻修患者于髋关节置换后3个月复查时发现1区有局限性透光带,无明显硬化带,患者无静息痛或活动疼痛,无全身发热、局部红肿表现,BACKGROUND： Cementless fixation for the femur following total hip arthroplasty （THA） has become a tendency. However, the efficacy of biological femoral stem for patients with severe osteoporosis caused by aging, menopause or ankylosing spondylitis still needs further validation. OBJECTIVE： To summarize the application of BetaCone double-tapered stem shape prosthesis for severe osteoporosis in THA. DESIGN, TIME AND SETTING： Retrospective case analysis was performed at Tianjin People＇s Hospital between October 2006 and January 2008. PARTICIPANTS： Eleven patients （11 hips） with severe osteoporosis undergoing THA in Tianjin People＇s Hospital were selected, including 4 cases with ankylosing spondylitis, 5 with aseptic loosening, and 2 with femoral neck fracture. Two of 4 cases with ankylosing spondylitis were bilateral affection, but only underwent unilateral THA. BetaCone double-tapered stem shape prosthesis was product of Link, Germany. METHODS： All patients underwent THA using posterior lateral approach. For patients with ankylosing spondylitis, wedge shaped osteotomy of femoral neck was firstly performed prior to THA. Following acetabular prosthesis implantation, an incision was made in the proximal femoral medullary cavity and medullary canal file was inserted at a correct anterior angle, followed by reduction of prosthesis. Hip function was evaluated using Harris scale before surgery. Anterior-posterior and lateral radiographs of the hip were taken to observe radiotransparent region and sclerosis （band）, prosthesis dislocation, attachment of prosthesis and the femur and prosthesis stability. MAIN OUTCOME MEASURES： THA efficacy and postoperative complications. RESULTS： All 11 patients were followed-up for 8.7 months averagely. Because this analysis was early report, only four cases with 6-month follow up were included in final analysis. The mean Harris score was 47.3 preoperatively and 83.2 postoperatively. The excellent and good rate was 90.1%. The position of prosthesis w

关 键 词：生物固定 假体 全髋关节置换 骨质疏松 

分 类 号：R681.4[医药卫生—骨科学]