生物型短柄假体在年轻患者Dorr C型股骨髓腔全髋关节置换中的应用  

Primary total hip arthroplasty with uncemented Tri-lock short stem in youth patients with Dorr type C proximal femoral morphology

作　　者：甄平[1] 李旭升[1] 周胜虎[1] 田琦[1] 常彦峰[1] 

机构地区：[1]兰州军区兰州总医院全军骨科中心关节外科,兰州市730000

出　　处：《中国矫形外科杂志》2018年第3期193-197,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81371983);甘肃省科技支撑计划项目(编号:S04671)

摘　　要：[目的]探讨应用Tri-lock生物短柄假体在年轻患者Dorr C型烟囱状髓腔进行髋关节置换的近期临床疗效。[方法]2011年10月~2013年11月,对17例(19髋)年轻患者烟囱状股骨髓腔采用圆锥形生物翻修柄假体行人工髋关节置换。男10例(12髋),女7例(7髋);年龄20~32岁,平均25.23岁。类风湿髋关节炎8例9髋;强直性脊柱炎7例8髋;股骨头无菌性坏死2例2髋。所有病例均合并不同程度的骨质疏松,按Singh指数分级:III级12例,II级5例。正位X线片上股骨近段髓腔形态均为Dorr C型,术后行X线片检查评估假体柄位置,Engh标准评价骨-假体界面稳定性,Harris评分标准评价髋关节功能。[结果]全部病例获17~43个月(平均31.51个月)随访。17例(19髋)Harris髋关节评分由术前(67.12±6.91)分(51~73分)提高至末次随访时(96.72±2.90)分(92~98分),差异有统计学意义(t=21.812,P<0.001)。术后即刻X线片均显示股骨短柄假体与髓腔紧密压配。末次随访时19髋均有明显股骨骨皮质增厚;15髋有不同程度股骨近端应力遮挡性骨吸收,其中Ⅰ度(股骨距密度低,且变圆钝)12髋,Ⅱ度(累及小转子)3髋。15髋有明显股骨骨皮质增厚,本组病例无大腿痛发生。[结论]锥形柄短柄化的Tri-lock生物短柄可良好充填Dorr C型烟囱状股骨近端髓腔并有效保留良好的股骨近端骨量,表面钛微孔涂层可有效增加假体摩擦力,短小的柄端在髓腔内的指向作用可有效避免髋内外翻的发生。[Objective] To investigate the short-term clinical outcome of total hip arthroplasty with uncemented Tri-lock short stem in youth patients with Dorr type C proximal femoral morphology. [Methods] From October 2011 to November 2013, 17 patients （19 hips） with Dorr type C proximal femoral morphology underwent total hip arthroplasty with uncemented Tri-loek short stem in our hospital. The patients, I0 males and 7 females aged from 22 to 32 years with an average of 25.23 years, consist- ed of 8 cases （9 hips） of rheumatoid arthritis, 7 cases （8 hips） of ankylosing spondylitis （AS） and 2 eases （2 hips） of avascular ne- crosis. The X-ray demonstrated that the proximal femoral bone morphology meet to Dorr type C in all of 19 hips of （described as stovepipe - shaped, with a wide femoral canal and thin cortices） . Postoperative X-ray examination was conducted to analyze the location of femoral prostheses and evaluate the stability of the prosthesis-bane interface, and Harris score was used to evalu- ate the hip function. [Results] All patients were followed up for an average of 31.51 months ranged from 17 to 43 months. The Harris hip score statistically improved from （67.12±6.91） preoperatively to （96.72±2.90） at the latest follow-up （t=21.812, P〈 0.001）. The initial postoperative X-ray showed good canal filling in all chimney-type femoral canals, additionally, the X-rays after operation showed cortical hypertrophy in proximal femur in the latest follow-up. There was no thigh pain occurred in anypatients. [Conclusion] Uncemented Tri-lock short stem has a good stem-canal fitting and bone-conserving capacity for the Dorr type C proximal femoral morphology. Proximally po- rous-coated tapered designs with a reduced distal end of the tern can provide physiologic loading to the proximal part ofthe femur.

关 键 词：股骨 髓腔 Dorr C型 关节成形术 短柄 生物型 

分 类 号：R687.4[医药卫生—骨科学]