严重股骨近端畸形的全髋关节置换术中股骨侧重建策略  

Surgical strategy in total hip arthroplasty for reconstruction of proximal femur with severe deformity

作　　者：易诚青[1] 马春辉[1] 周晓凯[1] 张国桥[1] 曹云[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,上海200080

出　　处：《上海交通大学学报（医学版）》2012年第12期1549-1553,1557,共6页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨严重股骨近端畸形病例全髋关节置换术(THA)的股骨侧重建策略。方法回顾性分析39例严重股骨近端畸形的THA病例,术前采用影像学检查评价股骨近端形态,术后随访THA的近中期并发症,测量双下肢长度与髋关节旋转中心恢复情况,观察截骨部位愈合情况和内固定的有效性。结果术前影像学检查可见严重股骨近端畸形,存在复杂的形态改变,28例涉及股骨大粗隆形态或位置异常。术后随访Harris评分平均为(82.00±2.57)分,较术前的(45.80±7.84)分明显改善,差异有统计学意义(P<0.01)。参照Linde-Jensen标准,39例THA的旋转中心恢复在真臼水平;手术并发症包括假体周围骨折、脱位、撞击;2例术后遗留0.5～1.5 cm下肢不等长,所有截骨部位获得骨性愈合。结论大粗隆形态和位置异常是股骨近端畸形的重要病理参数,需要依据术前评估制定个性化的THA股骨侧重建策略,其中软组织松解、截骨技术和假体选择是关键技术。Objective To investigate the optimal surgical strategy in total hip arthroplasty （THA） for reconstruction of proximal femur with severe deformity. Methods The clinical data of 39 patients with severe proximal femur deformity undergoing THA were retrospectively analysed. Imaging examinations were performed to assess the proximal femoral configuration before operation, short-term and mid-term complications were followed up after operation, leg length discrepancy and restoration of hip rotator center were evaluated, and fracture union and fixation stability were analysed in the site of osteotomy. Results Imaging examinations demonstrated complicated configuration change in the proximal femur, and mal-position or abnormal configuration of greater troehanter was found in 28 patients. Harris score significantly increased from （45.80 ± 7.84） points before operation to （ 82.00 ± 2.57） points after operation （ P 〈 0.01）. The rotator center was restored in the level of true acetabulum in all the 39 patients according to Linde-Jensen classification. Complications included peri-prosthetie fracture, hip dislocation and impingement. In spite of remaining 0. 5 - 1. 5 cm leg length discrepancy in 2 patients, bony healing was achieved in all osteotomy sites. Conclusion Location and configuration of the greater trochanter are considered as the most critical pathological parameters for establishing personalized THA strategy for severe deformity in proximal femur. Among the procedures, soft tissue release, osteotomy and prosthesis selection are the key techniques.

关 键 词：全髋关节成形术 股骨近端 畸形 

分 类 号：R687.3[医药卫生—骨科学]