全髋关节置换术中两种不同髋臼锉磨方式的疗效评价  

Effect of Two Different Methods Reaming Acetabular in Total Hip Arthroplasty

作　　者：崔凤金 武明鑫 白印伟[1] 蔡康 张文宙 付允 易志新 CUI Feng-jin;WU Ming-xin;BAI Yin-wei;CAI Kang;ZHANG Wen-zhou;FU Yun;YI Zhi-xin(Joint Surgery Department,Huizhou Third People＇s Hospital,Guangzhou Medical University,Huizhou 516002,China)

机构地区：[1]广州医科大学附属惠州市第三人民医院关节科,广东惠州516002

出　　处：《中山大学学报（医学版）》2018年第4期548-553,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省卫生厅课题(A2016A604)

摘　　要：【目的】评价人工全髋关节置换术中两种不同髋臼锉磨深度的疗效。【方法】对2015年3月至2016年2月在本院行人工全髋关节置换术的119例股骨颈骨折患者的临床及影像学资料进行回顾性分析,按随机数字表分为A、B组。A组患者锉磨髋臼时中央部分锉磨达到卵圆窝骨质,髋臼周边部分(前、后、上、下)达到软骨下骨或松质骨;B组患者锉磨髋臼时髋臼前、后壁露出软骨下骨,保留部分软骨下骨。比较2组患者手术时间、术中出血量、术中安装髋臼假体时是否容易达到稳定、术后3个月、2年髋关节Harris评分。【结果】与B组相比,A组患者平均手术时间长、出血量大,术中相对不易达到满意的初始稳定性(P<0.05);术后30 d,A组手术患者髋关节Harris评分(86.9±5.4)明显低于B组[(89.1±5.5),P<0.05]。术后2年,两组患者髋关节Harris评分没有统计学差别(P>0.05)。【结论】全髋关节置换术中锉磨髋臼仅达髋臼前后壁软骨下骨的方法比锉磨达到髋臼内壁的方法操作时间更短,术中髋臼假体更容易达到初始稳定性,术后短期可以获得较好的髋关节功能。【Objective】To observe the effect of reaming acetabular in two different depth on the outcome of total hip arthroplasty（THA）.【Methods】119 consecutive patients with femoral neck fracture scheduled for THA were divided randomly into 2 groups（group A and B）. For the patients in group A,we ream the fossa acetabuli until the subchondral bone in the superior wall revealed;for the patients in group B,we ream the fossa acetabuli until the subchondral bone in the anterior and posterior wall revealed,which means part of the subchondral bone in the anterior and posterior wall retained.Duration of surgery,amount of bleeding during surgery,the stability of the acetabular prothesis after first implantation,Harris hip score were recorded and analyzed.【Results】The operations for patients in group A take more longer time,with more amount of bleeding during operation contrast to group B（P〈0.05）. It＇s more difficult to obtain satisfied initial stability for the acetabular prosthesis in group A than in group B（P〈0.05）. The patients＇ HHS in group A are lower than that in group B 3 months after the operation（P〈0.05）whereas no statistical difference is found 2 years after the operation（P〈0.05）.【Conclusion】Retaining subchondral bone in the anterior and posterior acetabular wall is timesaving in THA,with less amount of bleeding and more easier to obtain initial stability during the operation,could achieve more satisfied function in short-term follow up.

关 键 词：人工全髋关节置换术 髋臼 锉磨 骨长入 

分 类 号：R318[医药卫生—生物医学工程]