全髋关节表面置换术治疗髋关节发育不良继发骨关节炎的早期疗效观察  

Treatment of osteoarthritis secondary to developmental dysplasia of the hip by total hip resurfacing arthroplasty

作　　者：沈彬[1] 黄强[1] 杨静[1] 周宗科[1] 康鹏德[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2010年第4期357-362,共6页Chinese Journal of Orthopaedics

基　　金：“十一五”国家科技支撑计划课题（2006BA116801）;国家863计划项目（2006AA02A135）

摘　　要：目的探讨全髋关节表面置换术（total hip resurfaeing arthroplasty，THRA）治疗成人髋关节发育不良（developmental dysplasia of the hip，DDH）继发骨关节炎的早期疗效。方法2005年3月至2006年6月，采用THRA治疗25位（26髋）DDH患者，女18例，男7例；年龄30-59岁，平均48岁。根据Hartofilakidis分型，半脱位22髋，低位脱位4髋。临床随访主要采用Harris评分，影像学测量指标包括CE角、Sharp角／臼杯外展角、股骨颈于角／柄于角、髋关节旋转中心、偏心距比值、髋臼假体覆盖率，记录髋臼假体周围透亮线及骨溶解，检测手术前后股骨颈及股骨近端的骨密度。结果所有患者平均随访3．5年（3-5年），截至随访终点无翻修或影像学松动病例，Harris评分由术前平均（46．1±6．57）分提高到术后平均（92．1±2．59）分，优良率100％。臼杯外展角平均为41．6°±5．5°，柄干角平均为146．4°±3．2°，髋关节旋转中心位置平均下移3．9mm，内移12．7mm，宿主骨对臼杯的平均覆盖率为94．4％±4．2％。1髋宿主骨与臼杯界面在Delee2区出现透亮线，宿主骨与股骨假体柄界面无1例出现透亮线。Green1-6区术后6个月骨密度比率降低，术后6-36个月骨密度比率均有不同程度的增加；术后6个月时股骨颈外上区、股骨颈内下区和Gruen7区骨密度比率已恢复至术前水平，术后36个月时上述三区的骨密度比率均高于术前。结论THRA治疗半脱位型及低位脱位型DDH继发骨关节炎患者具有良好的临床疗效，THRA术后股骨近端骨量可以得到有效保存和恢复。Objective To investigate the clinical effect of total hip resurfacing arthroplasty （THRA） for treatment of osteoarthritis secondary to the developmental dysplasia of the hip （DDH）. Methods From March 2005 to June 2006, 26 THRA were performed in 25 patients to treat osteoarthritis secondary to DDH. According to the Hartofilakidis classification, 22 hips were classified as dysplasia; 4 as low dislocation. Clinical outcomes were evaluated according to Harris score. Central-edge angle, abduction angle, stem-shaft angle, hip center, ratio of offset, cover rate of cup were measured radiologically. Bone mineral density was measured before and after THRA. Results The mean follow-up time of the 25 patients was 3.5 years. Using loosening or revision as the end point, the survival rate was 100%. The mean Harris hip score had improved from （46.1±6.57） points preoperative to （92.1±2.59） points at the final follow-up. Radiological measurement showed that the position of cup restored more anatomically after operation. At the sixth month after operation, the BMD ratio reduction occurred in ROI1-ROI 6, which then increased during 6 to 36 months. The BMD ratios of ROI7, ROLL, ROIM had returned to baseline value at the sixth month postoperatively and surpassed the reference by 36 months. Conclusion The clinical results of THRA for treatment of osteoarthritis secondary to DDH are encouraging. The bone stock of proxiaml femur can be reserved and restored effectively.

关 键 词：关节成形术 置换 髋 髋脱位 先天性 骨密度 

分 类 号：R687.4[医药卫生—骨科学]