髋关节表面置换治疗股骨头坏死与非坏死髋病的中长期对比  

Comparison of mid-long term outcomes of hip resurfacing arthroplasty for osteonecrosis versus non-osteonecrosis diseases

作　　者：周思佳 姜文学[1] 尤佳[1] ZHOU Si-jia;JIANG Wen-xue;YOU Jia(First Central Clinical College,Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院骨科,天津市300192

出　　处：《中国矫形外科杂志》2019年第1期16-21,共6页Orthopedic Journal of China

基　　金：天津市卫计委重点公关项目(编号:16KG102)

摘　　要：[目的]对比并分析髋关节表面置换术(HRA)分别治疗股骨头坏死(ONFH)和非骨坏死髋疾病的中长期疗效。[方法] 2005年6月～2015年8月共有73例84髋于本院施行了HRA,其中,ONFH 21例(23髋)定义为ONFH组,其他非骨坏死髋疾病52例61髋,定义为非ONFH组。测量髋关节活动范围(ROM)和Harris评分。此外,患者接受髋关节X线片、CT或MR的影像学检查评估。[结果] ONFH组和非ONFH组假体5年生存率均为100%。两组术后髋关节ROM均分别显著大于术前(P<0.05);尽管术前ONFH组患者的屈伸ROM小于非ONFH组(P<0.05),但两组末次随访时的髋关节各向ROM差异均无统计学意义(P>0.05)。两组间术前和末次随访时Harris评分差异无统计学意义(P>0.05),但两组末次随访时Harris评分均较术前显著提高(P<0.05)。ONFH组和非ONFH组股骨头囊性变直径、髋臼假体外展角和股骨假体柄干角的对比差异均无统计学意义(P>0.05)。共有13例不需要翻修的并发症:ONFH组4例,非ONFH组9例,所有患者均无股骨颈骨折和感染等严重并发症。[结论] ONFH和其他病因的患者在HRA术后可获得相当且满意的假体生存率和临床疗效。HRA为需要接受髋关节置换且要求良好中长期疗效的患者提供了合适选择。[Objective] To compare the mid-and long-term clinical outcomes of hip resurfacing arthroplasty(HRA) for osteonecrosis of the femoral head(ONFH) versus other non-osteonecrosis diseases. [Methods] From June 2005 to August 2015,73 patients(84 hips) underwent HRA in our hospital. Of them, 21 patients(23 hips) suffered from ONFH, while the remaining52 patients(61 hips) had other non-osteonecrosis diseases. The hip ranges of motions and Harris scores were recorded, in addition, imaging studies including X-rays, CT or MRI were available to assess the consequences. [Results] Both the ONFH group and non-ONFH group achieved prosthetic survival rate of 100% at 5 years postoperatively. The ROMs in flexion-extension, adduction-abduction, as well as internal and external rotations were significantly improved at the latest follow up compared with those preoperatively in both groups(P<0.05). No significant differences were found in the ROMs between the two groups at the latest follow up(P>0.05), although the flexion-extension ROM in the ONFH was significantly less than the non-ONFH group preoperatively(P<0.05). The Harris scores at the latest follow up significantly increased compared with those before operation in both groups(P<0.05), despite no significant differences between the two groups at any corresponding time points(P>0.05).Regarding to imaging evaluation, no significant differences were noticed between the two groups in diameter of cystic degeneration of femoral head preoperatively, as well as abduction angle of the acetabular component and stem–femoral shaft angle of femoral component at the latest follow up(P>0.05). A total of 13 complications that no need to be revised happened among 73 patients, 4 in the ONFH group and 9 in the non-ONFH group, however, no serious complications, such as femoral neck fracture and deep infection, occurred in anyone of them.[Conclusion] The hip resurfacing arthroplasty does achieve comparable consequences for both ONFH and non-ONFH hip associated with high prosthetic survival rate an

关 键 词：髋关节表面置换术 股骨头坏死 非骨坏死髋疾病 中长期疗效 

分 类 号：R681.8[医药卫生—骨科学]