双锥度生物固定型股骨柄治疗髋关节骨性融合的疗效  

TOTAL HIP ARTHROPLASTY WITH DOUBLE-TAPERED CEMENTLESS FEMORAL STEM FOR HIP BONY FUSION

作　　者：张强[1] 刘明[1] 柴伟[1] 张国强[1] 陈继营[1] 李众利[1] 董晓艳[1] 周勇刚[1] 王秀丽[1] 王岩[1] 

机构地区：[1]解放军总医院骨科北京,100853

出　　处：《中国修复重建外科杂志》2013年第3期278-282,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家高技术研究发展计划(863)资助项目(2011AA030101);国家自然科学基金资助项目(81101387)~~

摘　　要：目的通过与解剖型股骨柄比较,探讨对髋关节骨性融合患者采用双锥度生物固定型股骨柄行人工全髋关节置换的疗效。方法回顾分析1999年10月-2008年1月采用人工全髋关节置换治疗的50例80髋髋关节骨性融合患者临床资料,其中31例49髋采用BetaCone双锥度生物固定型股骨柄(试验组),19例31髋采用Ribbed解剖型股骨柄(对照组)。两组患者性别、年龄、病程、术前Harris评分及关节外展角度比较,差异均无统计学意义(P>0.05),具有可比性。术后X线片上测量两组外展肌力臂(a)、重力臂(b),计算其比值,并分析假体稳定性;随访测量关节外展角度,行Harris评分。结果术中9例9髋(试验组5例、对照组4例)发生骨折,经固定后骨折均愈合,假体稳定。术后患者均获随访,其中试验组随访时间12～98个月,平均49个月;对照组6～105个月,平均53个月。X线片复查示试验组a/b为0.65±0.25,对照组为0.56±0.37,差异有统计学意义(t=2.19,P=0.03);末次随访时假体位置稳定。术后6个月,试验组关节外展角度为(34.49±7.58)°,对照组为(30.97±7.24)°,均较术前显著改善(P<0.05),组间比较差异亦有统计学意义(t=2.06,P=0.04)。术后两组Harris评分均较术前显著提高(P<0.05),术后1个月试验组评分优于对照组(t=3.62,P=0.01),但末次随访时两组间差异无统计学意义(t=1.61,P=0.11)。术后2年试验组12例14髋、对照组8例9髋发生1～2级异位骨化。结论对于髋关节骨性融合患者,采用解剖型股骨柄及双锥度生物固定型股骨柄行人工全髋关节置换均可获得满意疗效,但双锥度生物固定型股骨柄置换术后早期具有更好的关节外展功能。Objective To investigate the effectiveness of total hip arthroplasty with double-tapered cementless femoral stem for hip bony fusion by comparing with anatomical cementless femoral stem. Methods A retrospective analysis was made on clinical data of 50 cases （80 hi ps） of hi p bony fusion undergoing total hip arthroplasty between October 1999 and January 2008. The patients were divided into 2 groups： 31 cases （49 hips） using BetaCone double-tapered cementless femoral stem （trial group）, and 19 cases （31 hips） using Ribbed anatomical cementless femoral stem （control group）. There was no significant difference in gender, age, disease duration, preoperative Harris score, and abduction angle of the hip between 2 groups （P 〉 0.05）. After operation, X-ray films were used to calculate the ratio of force arm of abductor （a） to the force arm of gravity （b） and analyze the stability of the prosthesis. The abduction angle of the hip and Harris score were measured during follow-up. Results Fracture occurred during operation in 9 hips of 9 cases （5 in trial group and 4 in control group）, and was cured after fixation. The mean follow-up time was 49 months （range, 12-98 months） in trial group and was 53 months （range, 6-105 months） in control group. The ratio of a/b was 0.65 ＋ 0.25 in trial group and was 0.56 ＋ 0.37 in control group, showing significant difference （t=-2.19, P=0.03）. The abduction angle of hip was （34.49 _＋ 7.58） in trial group and was （30.97 _＋ 7.24）. in control group at 6 months after operation, which was significantly improved when compared with preoperative value in 2 groups （P 〈 0.05）, and significant difference was found between 2 groups （t=2.06, P=0.04）. Postoperative Harris score was significantly improved in 2 groups when compared with preoperative score （P 〈 0.05）; trial group was better than control group in Harris score at 1 month after operation （t=3.62, P=0.01）, but no significant difference was found between 2

关 键 词：人工全髋关节置换术 骨性融合 双锥度生物固定型股骨柄 

分 类 号：R687.4[医药卫生—骨科学]