Wagner SL股骨柄用于髋关节翻修的适应证及疗效  

Short- term results of hip revision with Wagner SL implant

作　　者：徐海军[1] 陈廖斌[2] 王俊文[3] 程文俊[3] 郑琼[3] 勘武生[3] 

机构地区：[1]武汉市普爱医院骨科,湖北武汉430071 [2]武汉大学第二临床学院,武汉大学中南医院骨科,湖北武汉430071 [3]武汉市普爱医院,湖北武汉430033

出　　处：《中国矫形外科杂志》2016年第12期1062-1066,共5页Orthopedic Journal of China

摘　　要：[目的]通过临床病例总结,观察非组配型股骨柄Wagner SL用于国人髋关节翻修的初期临床疗效。[方法]2010年1月~2012年12月,共32例患者翻修术中使用单体型Wagner SL股骨柄。全髋术后股骨骨缺损按Paprosky分型,其中Ⅱ型19例,Ⅲa型11例,Ⅲb型2例。5例未行髋臼侧翻修。对每例患者术前术后进行Harris评分。通过双侧髋关节正位X线片测量评估肢体长度差异(Leg Length Discrepancy,LLD)。假体下沉的评估使用Callaghan等的方法。[结果]随访18~42个月,平均随访29.3个月。术前Harris评分(34.5±36.8)分,术后Harris评分平均(81.5±23.1)分。8例患者末次复查假体下沉≥5~<10 mm;1例复查股骨假体下沉>10 mm。均无明显症状。2例术后早期脱位。LLD:术前LLD≥2 cm 7例,≥1 cm 22例。术后末次随访LLD≥2 cm 2例,≥1 cm 8例,≥0.5 cm 17例。术后肢体差异较术前平均减小0.80 cm(1.8^-0.8 cm)。[结论]本组病例证实Wagner SL用于股骨侧Ⅱ,Ⅲa、Ⅲb型骨缺损翻修病例及部分假体周围骨折病例取得良好的初期效果,但在肢体长度差异调节准确性不足。[Objective]To evaluate the short- term results of Wagner SL stem used in hip revision. [Method] From Jan2010 to Dec 2012,32 hip revisions were completed with Wagner SL in our hospitalin. According to Paprosky classification of femoral deficiency,19 hips were of type Ⅱ,11 hips were type Ⅲ a,and 2 type IIIB. Five acetabulums were not revised. Leg length discrepancy（ LLD） were determined by AP X-rays of bilateral hips,both before and after hip surgeries. [Result]The mean follow up period were 29. 3 months,with a minimal of 18 months. The Harris score was average 34. 5 ± 36. 8 before surgery,and 81. 5 ± 23. 1 after surgery. Before surgery,7 patients were found with LLD ≧ 2 cm,and 22 patients LLD ≧ 1 cm. At last follow up,2 patients were found with LLD ≧ 2cm,and 8 patients with LLD ≧ 1cm. The mean LLD correction was 0. 80cm（ range,1. 8 cm- 0. 8 cm）. Implant subsidence were observed in 8 patients with more than 5mm,and particularly,1 patient with more than 10 mm. But they had no complains for no influence to bone integration. Two cases got early dislocations. [Conclusion]Hip revision with Wagner SL has good results in patients with type II,IIIA and IIIB bone deficiency,but LLD correction is not precise enough.

关 键 词：髋关节翻修 单体型假体 肢体长度差异 骨缺损 

分 类 号：R687.4[医药卫生—骨科学]