重度骨关节炎人工全髋关节置换术中偏心距重建  

METHODS OF OFFSIDE RECONSTRUCTION IN TOTAL HIP ARTHROPLASTY FOR SEVERE OSTEOARTHRITIS

作　　者：班照楠[1] 黄富国[1] 顾琪珊[1] 许冰[1] 李永奎[1] 李正疆[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2014年第8期947-950,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨髋关节重度骨关节炎行人工全髋关节置换术（total hip arthroplasty，THA）中偏心距重建方法以及疗效。 方法2009年7月－2011年6月，收治18例（18髋）髋关节重度骨关节炎患者。男14例，女4例；年龄47～72岁，平均55.4岁。病程11～74个月，平均33.6个月。左髋11例，右髋7例。髋关节Harris评分为（34.6 ± 5.3）分。托马斯征、“4”字试验以及Trendelenburg征均为阳性。术前肢体不等长15例。患者均行THA，术中采用股骨距标准截骨、选择正确的旋转中心及合适长度股骨距重建偏心距。 结果术后切口均Ⅰ期愈合。1例出现腓总神经牵拉损伤，经对症治疗3个月后恢复；其余患者均无手术相关并发症发生。18例均获随访，随访时间30～53个月，平均43.5个月。术后髋关节疼痛明显缓解，步态恢复正常。X线片复查示：关节无脱位，假体在位良好、无松动；6例双下肢不等长。患者健、患侧偏心距差值为0.1～0.7 mm，平均0.4 mm。末次随访时，髋关节Harris评分为（83.0 ± 7.1）分，与术前比较差异有统计学意义（t= —22.96，P=0.01）；关节活动度均较术前显著提高，差异有统计学意义（P 〈 0.05）。 结论髋关节重度骨关节炎行THA，通过术前模板测量选择合适假体，术中保留适当股骨距长度、调节股骨颈长度和颈干角，适度软组织松解，可准确重建偏心距，术后关节功能恢复满意。Objective To analyze the methods of offside reconstruction in total hip arthroplasty （THA） for severe osteoarthritis. Methods Between July 2009 and June 2011, 18 cases （18 hips） of severe osteoarthritis of the hip were treated by THA, including 14 males and 4 females with a mean age of 55.4 years （range, 47-72 years）. The disease duration was 11-74 months （mean, 33.6 months）. The left hip was involved in 11 cases and the right hip in 7 cases. The hip Harris score was 34.6 ± 5.3. The lower limb discrepency was observed in 15 cases. Thomas sign, Patrick sign, and Trendelenburg sign were positive in all cases. All patients received THA; during operation, standard femoral neck osteotomy was performed and the correct rotation center was chosen to reconstruct offside. Results All the incisions healed primarily. Common peroneal nerve injury occurred in 1 case and was cured after symptomatic treatment for 3 months, and the other patients had no complication. The mean follow-up period was 43.5 months （range, 30-53 months）. All patients achieved pain relief, and returned to normal gait. The X-ray films showed no dislocation of the hip or prosthetic loosening. Lower limb discrepency was observed in 6 cases. The mean offside difference between normal and ipsilateral side was 0.4 mm （range, 0.1-0.7 mm）. At last follow-up, the hip Harris score was 83.0 ± 7.1, showing significant difference when compared with preoperative score （t= — 22.96, P=0.01）; the hip range of motion was significantly increased when compared with preoperative one （P 〈 0.05）. Conclusion The offside reconstruction can accurately be carried out by making precise template and vernier caliper measurement, selecting suitable prosthesis preoperatively, maintaining the proper femoral calcar length, adjusting the length of the neck and neck-shaft angle, releasing the soft tissue reasonably during THA for severe osteoarthritis, and the short-term effectiveness is satisfactory.

关 键 词：重度骨关节炎 人工全髋关节置换术 偏心距重建 

分 类 号：R687.4[医药卫生—骨科学]