骨保留型股骨柄假体在年轻患者Dorr C型股骨髓腔中的应用  

Application of bone retaining femoral stem prosthesis in young patients with Dorr C femoral medullary cavity

作　　者：刘军[1] 屈涛 李旭升[1] 贾彬莉 甄平 李玉娟 田琦 王伟[1] 何晓乐 LIU Jun;QU Tao;LI Xu-sheng;JIA Bin-li;ZHEN Ping;LI Yu-juan;TIAN Qi;WANG Wei;and HE Xiao-le(Department of Communication Station Health Center,Lanzhou Joint Service,Western Theater,Lanzhou 730050,Gansu,China)

机构地区：[1]中国人民解放军联勤保障部队940医院全军骨科中心关节外科,甘肃兰州730050 [2]中国人民解放军联勤保障部队940医院麻醉手术科,甘肃兰州730050 [3]空军军医大学西京医院老年病科,陕西西安710032 [4]西部战区兰州联勤部通信总站卫生所,甘肃兰州730050

出　　处：《中国骨伤》2019年第9期785-791,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:81371983);全军后勤科研计划面上项目(编号:CWH17J009);全军医学科技青年培育计划(编号:19QNP047);甘肃省青年科技基金(编号:1606RJYA300);甘肃省卫生行业科研计划项目(编号:GSWSKY2018-21);甘肃省自然科学基金(编号:1606RJZA208)~~

摘　　要：目的:探讨应用Tri-lock生物短柄假体在年轻患者Dorr C型髓腔进行人工全髋关节置换的近期临床疗效。方法:2010年1月至2014年1月采用Tri-Lock BPS假体行全髋关节置换术治疗烟囱状股骨髓腔年轻患者35例(37髋),男18例(20髋),女17例(17髋);年龄21.2~38.5(32.2±3.0)岁。类风湿髋关节炎16例17髋,类风湿关节炎8例9髋,股骨头无菌性坏死11例11髋。所有病例合并不同程度的骨质疏松,按Singh指数分级:Ⅲ级26例,Ⅱ级9例。髋臼全部采用生物型假体,均采用陶瓷内衬,股骨头采用全陶瓷头。正位X线片上股骨近段髓腔形态均为Dorr C型,置换术后行X线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,并统计比较术前和末次随访时的髋关节活动度变化。结果:全部病例获得随访,随访时间18~45个月,平均33.8个月。35例(37髋) Harris髋关节评分由术前51.2~73.5(61.8±3.0)分提高至末次随访时92.5~98.8(93.3±6.5)分,差异有统计学意义(t=54.745,P<0.01)。髋关节活动度由术前0~55(46.5±8.0)°提高到末次随访时的85~130(101.2±10.5)°,差异有统计学意义(t=133.091,P<0.01)。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37髋均有明显股骨骨皮质增厚;22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)10髋。15髋有明显股骨骨皮质增厚,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 assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity. Methods:From January 2010 to January 2014,35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA,including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips),8 cases of rheumatoid arthritis (9 hips),and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index,26 cases were classified as Grade Ⅲ and 9 cases as Grade Ⅱ. Biological prostheses were used for the acetabulum,with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement,X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function,respectively. Changes of hip movement pre-operation and at last follow-up were compared. Results:All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (t=54.745,P<0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up,the difference was statistically significant(t=133.091,P<0.01). Immediately after surgery,the prostheses were tightly packed with the medullary cavity. At the final follow-up,17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral,including 9 degreeⅠ(low femur density,round and blunt) and 3 degreeⅡ(involving small rotor) hips. Meanwhile,15

关 键 词：骨髓腔 关节成形术 置换 髋 髋假体 

分 类 号：R687.4[医药卫生—骨科学] R684.3[医药卫生—外科学]