严重髋关节融合强直畸形的全髋关节置换术  

Total hip arthroplasty in treatment of serious hip fusion ankylosis deformity

作　　者：乐国平[1] 张明[1] 

机构地区：[1]广西医科大学第四附属医院骨科三病区,广西柳州市545005

出　　处：《中国骨与关节损伤杂志》2013年第6期509-511,共3页Chinese Journal of Bone and Joint Injury

基　　金：广西科学研究与计术开发计划项目(桂科基0342054)

摘　　要：目的探讨采用全髋关节置换术（THA）治疗严重髋关节融合强直畸形的手术方法及临床疗效。方法对48例（57髋）严重髋关节融合强直畸形分次行单侧THA，均采用外侧切口，通过对股骨颈2次截骨后，根据骨盆倾向头侧还是尾镧进行髋臼成形，正确定位臼杯的外展角，根据患侧屈曲畸形情况进行股骨柄和髋臼前倾角的调整。结果术后48例均获随访平均28．5（12—36）个月．1例一侧假体下沉4mm，1 例出现假体周围骨折，1 例出现股骨近端劈裂．1侧出现坐骨神经的牵拉伤。末次随访时，Harris评分从术前平均16．3分提高到85．6分；髋关节活动度由术前0°提高至术后平均152．5°，其中平均屈髋91．4°；髋关节屈曲畸形程度由术前平均25．6°改善至术后平均5．10°术后患者髋痛基本消失．术侧步态基本恢复正常，无严重并发症发生。结论严重髋关节融合强直屈髋畸形的THA不能按常规的方式处理，显露出真臼底和根据术前息肢的内旋或外旋程度把握好准确的前倾角、外展角是手术成功的关键。Objective To investigate the surgical methods and clinical efficacy of total hip arthmplasty （THA） for the serious hip fusion ankylosis deformity. Methods Forty eight patients（57 hips） with serious hip fusion ankylosis defonnity were treated with THA. All patients were treated with fullmottlod plug or nose plug, graded unilateral THA. The lateral incision was used, twice osteotomy of the femoral neck and pelvis tendency cephaliccandal acetabuloplasty were performed, the acetabular cup abduction angle were correctly positioned, femoral stem and acetabular anteversion adjustment was used to correct ipeilateral flexion deformity. Resalts All patients were followed up for 12-36 months （mean 28.5 months）. One case had prosthesis sinking 4 ram, one case had periprosthetic fracture, one case had proximal femoral splitting and one case had traction injury of the sciatic nerve. At the last follow-up, the Harris score improved from an average of 16.3 points to improve to 85.6 points. The hip preoperative activity improved from 0~ to the average postoperative total activity of 152.5~, the average hip flexion of 91.4~. Hip flexion deformity, preoperative average improved from 25.6~ to postoperative average of 5.1~. Postoperative hip pain disappeared; the operative side gait returned to normal no serious complications occurred. Conclusion THA in treatment of the serious fusion ankylosis hip flexion deformity can not be dealt with conventional manner. The true aeetabulum bottom should be exposed and good accurate anteversion and abduction angle should be taken according to preoperative internal rotation of the limb or external rotation. This is the key to successful operation.

关 键 词：髋关节强直 髋关节融合 全髋关节置换术 屈曲畸形 

分 类 号：R687.42[医药卫生—骨科学]