变异髋臼人工全髋关节置换中髋臼假体选择性上移安置的初步疗效分析  

SELECTIVELY UPWARD PLACEMENT OF ACETABULAR IMPLANTS IN PATIENTS WITH ANATOMICALLY ABNORMAL ACETABULUM DURING TOTAL HIP ARTHROPLASTY

作　　者：张志奇[1] 廖威明[1] 侯昌禾[1] 邬培慧[1] 康焱[1] 张紫机[1] 赵潇艺 

机构地区：[1]中山大学附属第一医院关节外科,广州510080

出　　处：《中国修复重建外科杂志》2014年第5期566-570,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81201388);中山大学临床研究5010计划项目(2013002)~~

摘　　要：目的探讨变异髋臼的人工全髋关节置换术（total hip arthroplasty，THA）中髋臼假体选择性上移放置的方法及疗效。 方法2005年1月－2010年12月，收治26例（26髋）拟行THA的变异髋臼患者。男5例，女21例；年龄35～67岁，平均52.3岁。左髋11例，右髋15例。其中发育性髋关节发育不良22例，股骨头缺血性坏死3例，创伤性关节炎1例。术前Harris 评分为（45.85 ± 10.04）分。常规行骨盆正位、患侧股骨正侧位 X 线片、骨盆 CT 平扫及三维重建检查，采用TraumaCad软件进行术前设计。THA术中在尽量接近真臼位置且避免大量结构性植骨前提下，根据具体情况适当上移旋转中心，使髋臼假体能获得70%以上骨性包容，旋转中心上移不超过15 mm。 结果11例患侧旋转中心基本与健侧一致（5 mm以内）；余15例行旋转中心上移，其中上移5～10 mm 8例，10～15 mm 7例。术中无骨折及神经损伤；术后患者切口均Ⅰ期愈合，无感染、下肢深静脉血栓形成等并发症发生。1例术后3 d发生关节脱位，经手法复位保守治疗后无再脱位。患者均获随访，随访时间15～71个月，平均34个月。末次随访时，Harris 评分达（91.42 ± 3.59）分，较术前显著提高（t=20.099，P=0.000）；其中旋转中心基本与健侧一致、上移5～10 mm、10～15 mm者 Harris评分分别为（92.09 ± 4.04）、（91.25 ± 2.82）和（90.57 ± 3.95）分，各组间比较差异无统计学意义（F=0.377，P=0.690）。X线片复查示，随访期间假体均无松动、下沉。 结论 变异髋臼THA中以髋臼假体旋转中心尽可能放置在接近真臼位置前提下，适当上移（≤15 mm）假体以获得至少70%骨性包容和良好自身稳定性，可获得满意中期疗效，远期疗效有待进一步随访观察。Objective To investigate the method and effectiveness of selectively upward placement of acetabular implants in patients with anatomically abnormal acetabulum during total hip arthroplasty （THA）. Methods Twenty-six cases （26 hips） of anatomically abnormal acetabulum received THA between January 2005 and December 2010, including 22 cases of developmental dysplasia of the hip, 3 cases of osteonecrosis of the femoral head, and 1 case of post-traumatic arthritis. There were 5 males and 21 females with an average age of 52.3 years （range, 35-67 years）. The left hip was involved in 11 cases and the right hip in 15 cases. The preoperative Harris score was 45.85 ± 10.04. The anteroposterior X-ray films and CT scan of the pelvis, anteroposterior and lateral X-ray films of the femur, and TraumaCad analysis were performed routinely before operation. The principles of acetabular implants were that more than 70% of the bone-implant interface was covered, and the upward distance of acetabular implant was less than 15 mm. Results Acetabular implants were placed within 5 mm from the anatomical rotation center in 11 cases. The upward distance of acetabular implant was 5-10 mm in 8 cases and was 10-15 mm in 7 cases. No bone fracture or nerve injury was observed intraoperatively. All incisions healed by first intention, and no infection or lower limb deep venous thrombosis occurred. One case had dislocation at 3 days after operation, and was cured after reduction and conservative treatment. The follow-up time ranged from 15 to 71 months （mean, 34 months）. The Harris score was 91.42 ± 3.59, showing significant difference when compared with preoperative score （t=20.099, P=0.000）. The Harris scores were 92.09 ± 4.04 in patients having less than 5 mm upward distance, 91.25 ± 2.82 in patients having 5-10 mm upward distance, and 90.57 ± 3.95 in patients having 10-15 mm upward distance, showing no significant difference （F=0.377, P=0.690）. No loosening or subsidence of the implant was observed by X-ray film du

关 键 词：变异髋臼 人工全髋关节置换术 髋臼放置 选择性上移 

分 类 号：R687.4[医药卫生—骨科学]