354例Ribbed股骨柄假体置换术的中远期疗效分析  

Mid-and long-term effectiveness of total hip arthroplasty with Ribbed femoral stem prosthesis in 354 cases

作　　者：杨涛[1] 谢杰[1] 胡懿郃[1] 安森博 汪龙[1] YANG Tao;XIE Jie;HU Yihe;AN Senbo;WANG Long(Department of Orthopaedics,Xiangya Hospital of Central South University,Changsha Hunan,410008,P.R.China)

机构地区：[1]中南大学湘雅医院骨科

出　　处：《中国修复重建外科杂志》2019年第9期1116-1120,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81601883);湖南省自然科学基金资助项目(2018JJ3861)~~

摘　　要：目的探讨采用Ribbed股骨柄假体行人工全髋关节置换术(total hip arthroplasty,THA)的中远期疗效。方法回顾分析2006年10月—2016年5月采用Ribbed股骨柄假体行THA且获完整随访的354例(384髋)髋关节疾病患者临床资料。男171例,女183例;年龄20~82岁,平均53.4岁。单髋324例,双髋30例。关节置换原因:股骨头缺血性坏死151例(159髋),髋关节骨关节炎134例(136髋),类风湿性关节炎43例(43髋),强直性脊柱炎20例(40髋),创伤6例(6髋)。术前患者Harris评分为(42.34±8.89)分。术后采用Harris评分评价髋关节功能;摄X线片判断双下肢是否等长、股骨侧有无透亮带、假体稳定性以及应力遮挡发生情况。结果术后切口均Ⅰ期愈合。354例患者均获随访,随访时间2~11年,平均7.4年。末次随访时Harris评分为(80.52±7.61)分,与术前比较差异有统计学意义(t=134.804,P=0.000)。术后发生2例(2髋)假体感染,3例(3髋)假体松动,4例(4髋)假体周围骨折,48例(48髋)存在轻到中度大腿疼痛。X线片示76例(78髋)股骨侧存在透亮线以及不同程度应力遮挡。按照Engh等的方法评价假体稳定性,骨长入性稳定364髋,纤维长入性稳定15髋,假体不稳定5髋。25例(25髋)发生股骨柄假体下沉,其中5例患者双下肢长度差异>10 mm。结论采用Ribbed股骨柄假体行THA具有初始稳定性好、骨长入好等优点,术后应力遮挡发生率相对较高,但对假体中远期生存率和疗效无明显影响。Objective To evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis. Methods A clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding. Results The incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score (t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh's method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients. Conclusion THA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth

关 键 词：人工全髋关节置换术 Ribbed股骨柄 非骨水泥型假体 

分 类 号：R687.4[医药卫生—骨科学]