股骨近端弯曲畸形采用股骨截骨联合组配式生物柄假体的全髋关节置换术  

Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity

作　　者：甄平[1] 李旭升[1] 刘军[1] 田琦[1] 周胜虎[1] ZHEN Ping;LI Xusheng;LIU Jun;TIAN Qi;ZHOU Shenghu(Department of Orthopaedic,Lanzhou General Hospital of PLA,Lanzhou 730050,China)

机构地区：[1]兰州军区兰州总医院骨科中心,兰州730050

出　　处：《中华骨与关节外科杂志》2019年第1期13-17,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:股骨近端畸形存在严重解剖结构异常,导致全髋关节置换治疗具有手术复杂、耗时长、技术要求高、术后并发症发生率高、疗效差等特点。目的:探讨股骨近端畸形部位截骨矫正联合组配式生物柄假体进行股骨固定与重建的全髋关节置换的近期临床疗效。方法:2012年8月至2014年9月,应用股骨畸形部位截骨联合组配式S-ROM生物型假体行全髋关节置换术治疗合并股骨近端弯曲畸形的髋关节疾病患者12例(12髋)。其中男10例,女2例;年龄38～52岁,平均43.5岁。12例均为并发股骨近端转子下部位弯曲畸形的晚期髋关节病变,其中髋关节发育不良6髋,先天性髋关节脱位行股骨截骨术后3髋,股骨近端骨折术后2髋,陈旧性化脓性髋关节炎1髋。记录术前肢体短缩、术中截骨及术后肢体长度,对临床结果采用髋关节Harris评分进行评价,术后复查X线片观察假体位置,是否有骨溶解、假体松动、下沉等。结果:12例患者均获得术后随访,随访时间20～55个月,平均42.5个月。术后患者双下肢不等长相差(1.0±0.5)cm,与术前(3.2±1.2)cm比较差异有统计学意义(t=-2.501,P=0.002)。Harris评分为由术前平均(47.2±9.9)分提高至末次随访的(89.7±3.9)分,与术前比较差异有统计学意义(t=21.31,P=0.001)。术后即刻X线检查示股骨截骨后下肢力线恢复,假体柄初始生物压配固定牢固,髓腔填充良好。依据Engh骨长入标准12髋均为稳定骨长入。无感染、假体松动、假体周围骨折等并发症的发生。结论:伴有股骨弯曲畸形患者行全髋关节置换术时,精确的股骨截骨、紧密的截骨断端髓腔对合以及正确应用组配式S-ROM假体进行股骨重建与固定是手术成功的关键。Background:Due to distorted anatomy of proximal femoral deformity,total hip arthroplasty(THA)in these cases represents technically demanding procedure and often gives rise to relatively high rate of complications.Objective:To evaluate the efficacy of THA with femoral osteotomy and S-ROM prosthesis in patients with proximal femoral deformity.Methods:Twelve patients(12 hips)who suffered from advanced hip arthropathy complicated with proximal femoral subtrochanteric deformity and underwent THA combined with femoral osteotomy and S-ROM prosthesis between August 2012 and September 2014 were enrolled in this retrospective study.There were 10 males and 2 females with an average age of 43.5 years(range,38-52 years).The diagnosis included developmental dysplasia of the hip(DDH,6 hips),previous osteotomy resulted from congenital dislocation of the hip(3 hips),previous fracture(2 hips),and old pyogenic infection of the hip(1 hip).Preoperative limb shortening,osteotomy length and postoperative limb lengthening were recorded.Hip joint function was evaluated according to the Harris hip score.Radiography was used to determine prosthesis position and check for complications(osteolysis,prosthetic loosening and sinking)after surgery.Results:All the patients were followed up for an average of 42.5 months(range,20-55 months).Postoperative leg-length discrepancy was significantly shorter than preoperative one([1.0±0.5]cm vs[3.2±1.2]cm,t=-2.501,P=0.002).The Harris hip score was significantly increased at the finial follow-up as compared with preoperative one(89.7±3.9 vs47.2±9.9,f=21.31,P=0.001).Radiographs showed that the limb alignment was corrected after femoral osteotomy and femoral stem prosthesis was in good position and stable fixation.According to Engh’s criteria,stable bone ingrowth was found in all the 12 hips.No infection,prosthesis loosening,or periprosthetic fractures occurred.Conclusions:Accurate osteotomy,close coaptation of the medullary cavity and proper S-ROM prostheses implanting are the keys to the operation i

关 键 词：股骨近端畸形 股骨截骨 全髋关节置换术 组配式人工关节假体 股骨重建 

分 类 号：R687.4[医药卫生—骨科学]