全髋关节置换术治疗晚期髋臼发育不良  

Total Hip Arthroplasty for The Treatment of End-stage Acetabular Dysplasia

作　　者：李宇俊[1] 文立成[2] 曹永平[2] 杨昕[2] 

机构地区：[1]北京仁和医院骨科,北京102600 [2]北京大学第一医院骨科,北京100034

出　　处：《实用骨科杂志》2012年第3期203-206,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨全髋关节置换术治疗晚期髋臼发育不良致髋关节骨关节毙时人工髋臼的安放方法。方法对2002年1月至2008年1月因髋臼发育不良导致骨关节炎行全髋关节置换术的病例进行随访，有52例（60髋）获得随。访。其中男6例，女46例；年龄46-72岁，平均62岁；双髋8例，单髋44例。主要症状为疼痛及跛行。在行人工全韫置换术时，根据髋臼发育不良的程度，采用了加深髋臼、髋臼内陷及髋臼外上缘植骨等三种方法。术后随访应用Harris评分进行髋关节功能评价，术后第3、6、9、12个月及以后每1年以同等条件投照双髋关节正位x线片，观察髋目假体与髋臼骨床愈合的情况。随访2-8年，平均4年6个月。结果加深髋臼和髋臼内陷的病例，髋臼假体与髋臼骨床接触良好，无松动，关节功能恢复优良。而髋臼外上缘植骨的6髋中有5髋，术后2年时植骨块与髋臼假体间出现透亮带，但髋臼假体无松动。结论髋臼发育不良导致髋关节骨关节炎的病例在施行人工关节置换术时应根据髋臼骨床的情况采用不同的手术方式安放人工髋臼。在髋臼底部骨质较多的情况下，应采用加探髋臼的方法。一加深髋臼后仍有少量髋臼假体外露时可采用髋臼内陷安放人工髋臼。髋臼外上缘结构植骨的患者仍需长期随访观察。To explore the installing methods of hip prothesis in a total hip arthroplasty for patients of osteoarthritis secondary to end-stage acetabular dysplasia. Methods Between January 2002 and January 2008,a total of 60 hips in 52 patients with advanced osteoarthritis secondary to acetabular dysplasia underwent the total hip arthro- plasty and were followed up. Among the patients, 6 were male and 46 were female,with their ages ranging from 46 to 72 years and a average age of 62 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 44 patients. The main symptoms were pain and claudication. According to the developmental degree of acetabulums,three methods were adopted to perform the total hip arthroplasty,which were deepen acetabulum,in- ward deepening acetabulum and bone transplantation on external upper lip of acetabulum. The Harris scores were ap- plied to evaluate function of the hip during follow-up. X-ray films for both joints were taken in order to learn the coa- lescence of acetablum with its bone bed after a, 6,9,12 months and every 1 years after operation. The follow-up time ranged from 2 years to 8 years ,with an average of 4 years and 6 months. Results At the end of f011ow-up,the acetab ulum prostheses contacted well with their beds of 45 years and the recovery of joint function was satisfactory and no sign of aseptic loosening among the cases of deepen acetabulum and inward deepened acetabulum. However,in 5 of 6 acetabulums which implanted bone on their external upper lip,there was a radiolueency between the implanted bone and the acetabulum prothesis after 2 years of the operation. No sign of aseptic loosening was found. Conclusion While performing total hip arthroplasty,various methods should be adopted according to the bed of acetabulum for the joints of osteoarthrosis due to acetabulum dysplasis. For the patient of enough bone at the bottom of aeetabulum bed,; the acetabulum should be installed by the operation methods of deepen acetabulum. For the patients wi

关 键 词：关节成形术 置换 髋臼 骨关节炎 

分 类 号：R687.42[医药卫生—骨科学]