人工全髋关节置换术治疗先天性髋关节脱位72例报告  

Total hip arthroplasty for congenital dislocation of the hip: a report of 72 cases

作　　者：万斌[1] 吕征[1] 周锦春[1] WAN bin;LV Zheng;ZHOU Jinchun(Department of Orthopaedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中国骨科临床与基础研究杂志》2018年第4期233-237,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的探讨人工全髋关节置换术(THA)治疗先天性髋关节脱位(CHD)的临床疗效。方法回顾性分析2013年1月至2016年6月南京医科大学第一附属医院采用THA治疗的72例CHD患者的临床资料。记录患者切口愈合和并发症发生情况,观察假体初始固定位置、假体位移和股骨-假体界面稳定性,计算假体髓腔填充率,比较患者手术前后Harris髋关节功能评分及肢体短缩长度变化。结果术后切口均Ⅰ期愈合,无神经损伤、下肢静脉血栓形成及髋关节再脱位并发症发生。67例患者股骨假体初始位置处于中立位固定、2例轻度外翻、2例外翻固定、1例内翻固定。患者随访时间24～28个月,平均随访时间(26.6±1.5)个月。末次随访时假体髓腔股骨柄填充率(80.5±2.2)%,股骨柄远端、中部、近端填充率分别为(84.9±2.9)%、(79.8±2.9)%和(88.7±3.1)%;股骨-假体界面稳定性为100%,髋臼-假体界面稳定性94%;Harris髋关节功能评分、肢体短缩长度较术前明显改善(P <0.05)。结论 THA治疗CHD具有股骨假体初始位置固定牢靠、假体填充率高、股骨-假体界面稳定性优良、髋关节功能恢复良好、肢体短缩改善明显等优势,疗效满意。Objective To discuss the clinical effect of total hip arthroplasty （THA） in treatment of congenital hip dislocation （CHD）. Methods Clinical data of 72 CHD patients treated by THA in the First Affiliated Hospital of Nanjing Medical University from January 2013 to June 2016 were retrospectively analyzed.Patients＇ incision healing and complications were recorded, the initial fixation position of femoral prosthesis,prosthesis migration as well as the stability of femur-prosthesis interface were observed, the filling rate of prosthetic medullary cavity was calculated, and Harris hip function score and limb shortening length were compared between preoperation and postoperation. Results All incisions healed in the first stage without complications such as nerve injury, venous thrombosis of lower limbs and dislocation of hip joint. The initial position of femoral prosthesis was fixed in neutral position in 67 cases, slight eversion in 2 cases, eversion in 2 cases and inversion in 1 case. The patients were followed up for 24 to 28 months, with the average follow-up time of （26.5 ± 1.5） months. Up to the last follow-up, the filling rate of the prosthetic medullary cavity was （80.5 ± 2.2）%, and the filling rates of the distal, middle and proximal femoral stems were （84.9 ± 2.9）%, （79.8 ± 2.9）% and （88.7 ± 3.1）% , respectively. The stability of femur-prosthesis interface was 100% , and the acetabulumprosthesis interface stability reached 94%. At the last follow-up, Harris hip function score and limb shortening length were significantly improved compared with those before operation. Conclusion Curative effect of THA for CHD is satisfactory, with the advantages of firm fixation of the initial position of femoral prosthesis, high filling rate of prosthetic medullary cavity, good stability of femur-prosthesis interface and acetabulum-prosthesis interface, rapid recovery of hip joint function, and obvious improvement of limb shortening.

关 键 词：关节成形术 置换 髋 髋脱位 先天性 髋假体 手术后并发症 

分 类 号：R687.42[医药卫生—骨科学] R684.75[医药卫生—外科学]