非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的应用  

Application of SL-PLUS/SLR-PLUS cementless stem prosthesis in treating femoral bone defects in total hip revision surgery

作　　者：王健[1] 肖军[1] 赵亮[1] 李涛[1] 张洋[1] 张贤祚[1] 史占军[1] 

机构地区：[1]南方医科大学南方医院关节与骨病外科,广州510515

出　　处：《中华骨科杂志》2016年第23期1517-1523,共7页Chinese Journal of Orthopaedics

基　　金：广东省科技计划项目（2014A020209034）

摘　　要：目的探讨髋关节翻修术中股骨侧应用非骨水泥锥形方柄行“非完全结构重建”的可行性及疗效。方法回顾性分析2000年10月至2014年4月髋关节置换术后因股骨侧松动而翻修且近端结构有骨缺损的患者57例，男22例，女35例；年龄44-83岁，平均62岁。均为单侧手术，左侧21例，右侧36例。股骨侧骨缺损Paprosky Ⅱ型18例、ⅢA型23例、ⅢB型16例。应用矩形截面SL-PLUS／SLR．PLUS非骨水泥柄对股骨侧进行翻修，劈开股骨取假体12例，均不植骨。同时行髋臼侧翻修或成形术51例，使用球形臼杯33例、加强环18例。术后随访观察假体周围透光线、骨溶解、下沉等松动迹象。以疼痛视觉模拟评分（visual analogue scale，VAS）、Harris髋关节评分、日常活动能力（activity daily life，ADL）量表Barthel指数评估临床疗效。结果手术时间100-170min，平均108min；术中出血量300~850ml，平均660ml。假体植入后均实现即刻生物压配，术中未发生神经及血管损伤，术后切口均I期愈合，无神经牵拉损伤、关节脱位、骨折、急性感染及下肢深静脉血栓形成等并发症。术后随访2-16年，平均4．8年。末次随访时疼痛VAS评分从术前（6．54±1．56）分下降至（2．28±1．46）分，差异有统计学意义（t=17．335，P〈0．001）；Harris髋关节评分由术前（46．74±7．95）分提高至（78．46±8．25）分，差异有统计学意义（t=-25．012，P〈0．001）；ADL量表Barthel指数从术前（56．84±6．86）分提高至（69．39±7．56）分，差异有统计学意义（t=-21．309，P〈0．001）。随访期间无假体下沉、假体柄断裂等并发症发生。18例假体柄上段周围出现透光线，但中段及远段整合良好。结论应用矩形截面SL-PLUS／SLR-PLUS非骨水泥柄对股骨侧Paprosky Ⅱ型及Ⅲ型骨缺损进行翻修，行功能重建而非植骨“结构重建”，术后可获得较满意的近中期疗效�Objective To investigate the technique and clinical results of rectangular SL-PLUS/SLR-PLUS cementless stem prosthesis in treating femoral bone defects in total hip revision surgery. Methods A retrospective analysis was per- formed involving 57 patients underwent total hip revision using SL-PLUS/SLR-PLUS cementless stem prosthesis for femoral de- fects from October 2000 to April 2014, including 22 males and 35 females with average age 62 years （range 44 to 83 years）. All patients underwent unilateral surgery, 21 in the left and 36 in the right. Eighteen cases of Paprosky Ⅱ, 23 cases of type ⅢA and 16 cases of type ⅢB were included. Revision surgeries were performed using uncemented rectangular SL-PLUS/SLR- PLUS femoral stems. Femurs were split in 12 cases without bone grafting. Acetabulum revision or acetabuloplasty were con- ducted in 51 cases by the use of 33 spherical cups and 18 reinforcement rings. Signs for prosthesis loosing such as transparent line around prosthesis, osteolysis and subsidence were recorded at the follow-ups. The clinical effects were evaluated using vi- sual analogue scale （VAS）, Harris score and activity daily life （ADL） score. Results The average operation was 108 min, rang- ing from 100 to 170 rain. The average blood loss was 660 ml, ranging from 300 to 850 ml. All prostheses were placed optimally and received ＂press-fit＂ stability in the initial state. No neurological or vascular complication occurred during or after the operation. All incision healed at stage I without nerve traction injury, joint dislocation, fractures, acute infection and lower limb deep vein thrombosis. The average follow-up duration was 4.8 years, ranging from 2 to 16 years. Total VAS improved from 6.54±1.56 to 2.28± 1.46 （t=17.335, P〈0.001）. The Harris score improved from 46.74±7.95 to 78.46±8.25 （t=-25.012, P〈0.001）, and the ADL scores increased from 56.84＋6.86 to 69.39±7.56 （t=-21.309, P〈0.001）. No prosthesis subsidence, prosthesis fracture and other complica- tio

关 键 词：关节成形术 置换 髋 假体失效 再手术 股骨 骨质溶解 

分 类 号：R687.3[医药卫生—骨科学]