楔形股骨假体在Dorr C型髓腔病例中的应用  

The role of the wedge stem in the patients with Dorr type C femoral morphology in total hip arthroplasty

作　　者：张纪[1] 唐竞[1] 黄德勇[1] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《骨科临床与研究杂志》2017年第3期171-180,共10页Journal Of Clinical Orthopedics And Research

基　　金：北京市科委科技计划项目(D121100004212002)~~

摘　　要：目的探讨人工全髋关节置换术(artificial total hip replacement,THR)中楔形柄应用于Dorr C型髓腔的短期临床及放射学结果。方法选取2014年1—12月北京积水潭医院矫形骨科行THR治疗并应用某一款楔形柄植入Dorr C型髓腔的57例(68髋)患者,年龄22~82岁,平均58岁;体质量指数(body mass index,BMI)16~31 kg/m2,平均23 kg/m2。所有患者的手术均经后外侧入路完成,临床评价指标包括术前、术后Harris髋关节评分(HHS),围手术期并发症,大腿痛发生情况等。影像学评价指标包括股骨假体力线有无明显下沉、位置改变等松动表现,同时判断有无透亮线、硬化线、骨溶解、异位骨化及应力遮挡等放射学改变。结果所有患者均获得2.0~2.8年的临床及放射学随访资料,至最近一次随访,均未发现股骨假体临床或放射学松动现象。HHS评分从术前的43分改善为术后的88分。围手术期并发症:术中股骨假体周围骨折2髋(2.9%),切口愈合不良1髋(1.4%),术后轻度大腿痛2髋(2.9%)。股骨假体中置30髋(44.1%),不同程度股骨假体外翻38髋(55.9%),无股骨假体内翻者。术后X线片影像资料均未发现股骨假体位置改变。股骨假体周围硬化8髋(11.8%),均位于Gruen 4区,附近皮质骨均无形态改变。Brooker 1级异位骨化1髋(1.4%)。结论 THR中楔形柄应用于Dorr C型股骨髓腔可以获得良好的短期临床疗效。Objective To investigate the short-term outcome of the wedge stem in artificial total hip arthroplasty （THA） in patients with Dorr type C femoral morphology. Methods A total of 57 patients （68 hips） who had undergone THA from January to December 2014 were included in the study for the Dorr type C femoral morphology and the use of a kind of wedge stem. The mean age of the patients was 58 years （22 -82）, and the mean BMI was 23 （16-31）. Surgery was performed using posterolateral approach. We assessed the improvement of Harris Hip Score （HHS） after THA and the incidence of perioperative complications and thign pain. Radiographic assessments included the alignment and the signs of radiographic loosening such as subsid-ence or position change of the stems. Meanwhile, we documented the radiographic changes such as radiolucent line, cortical hypertrophy, osteolysis, heterotopic ossification, and stress shielding. Results All patients had a minimal 2 years （2.0 -2.8） follow-up and were available for clinical assessment and radiographic review. Until the latest follow-up, no femoral component was loose by clinical or radiographic criteria. The mean HHS im-proved from 43 points to 88 points at final follow-up. Peri-operative complications included intra-operative periprosthetic femoral fracture in 2 hips （2. 9% ） and poor wound healing in 1 hip （1 .4% ） . There was neutral stem alignment in only 30 hips （44. 1% ） and valgus in 38 （55. 9% ） , no varus stem alignment was found. Eight hips （11.8%） showed a pedestal in the tip of the stems （ Gruen 4 ） , without cortical hypertrophy. One hip （1.4% ） was found a Brooker 1 heterotopic ossification. Conclusion Excellent short-term outcome can be achieved using the wedge stems in patients with Dorr type C femoral morphology in THA.

关 键 词：髋关节 关节成形术 髋假体 

分 类 号：R687.4[医药卫生—骨科学]