髓腔解剖交锁股骨假体人工全髋关节置换术后骨改建及远期临床疗效  

Bone remodeling after total hip arthroplasty with anatomic medullary locking prosthesis and its long-term effectiveness

作　　者：李永旺[1] 何荣丽[2] 张谦[1] 安明[1] 祁辉[1] 马文海[1] 宋兴建[1] 孙俊英[3] LI Yongwang;HE Rongli;ZHANG Qian;AN Ming;QI Hui;MA Wenhai;SONG Xingjian;SUN Junying(Third Department of Orthopedics,Baoding Municipal First Center Hospital,Baoding Hebei,071000,P.R.China;Department of Gastroenterology,Baoding Municipal Second Hospital,Baoding Hebei,071000,P.R.China;Department of Orthopedics,First Affiliated Hospital,Soochow University,Suzhou Jiangsu,215006,P.R.China)

机构地区：[1]保定市第一中心医院骨三科,河北保定071000 [2]保定市第二医院消化内科,河北保定071000 [3]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国修复重建外科杂志》2020年第6期689-695,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用髓腔解剖交锁(anatomic medullary locking,AML)股骨假体行人工全髋关节置换术(total hip arthroplasty,THA)后股骨骨改建情况及远期临床疗效。方法回顾分析1997年11月-2003年1月应用AML股骨假体行THA治疗的24例(26髋)患者临床资料。男12例,女12例;年龄32~69岁,平均53.7岁。股骨头缺血性坏死5例(5髋),髋臼发育不良继发骨关节炎6例(7髋),股骨颈骨折6例(6髋),原发性骨关节炎2例(2髋),翻修术3例(3髋),强直性脊柱炎1例(2髋),股骨头骨折1例(1髋)。术后即刻、6周、3个月、6个月、1年及之后每年定期随访,分别行影像学评估(术后即刻摄X线片评价股骨峡部压配情况,Engh标准评定股骨柄假体生物学固定情况,术后发生异位骨化情况采用Brooker法评定);骨改建评估[假体与骨界面的改建(记录骨反应的类型、Gruen分区、发生率及出现时间),假体周围骨改建(根据Engh和Bobyn法评定股骨近端应力遮挡性骨吸收,并测量骨密度变化率)];临床疗效评估[Harris评分评价疗效、疼痛视觉模拟评分(VAS)评定大腿痛]。结果术后患者均获随访,随访时间15年2个月~20年4个月,中位随访时间16年6个月。术后即刻24髋(92.3%)股骨峡部压配良好,24髋(92.3%)有骨长入。术后3~6个月发生异位骨化1度2例、2度2例、3度1例。增生性骨反应多见于Gruen 2、3、4、5、6、10、11、12区,主要发生于术后6~20个月,发生率3.8%~69.2%,其中点焊征发生率最高;吸收性骨反应均为骨溶解,多见于Gruen 1、7区,主要发生于术后8年后,发生率42.3%,未见透亮线(区)、髓腔扩大征发生。21髋(80.8%)发生1度应力遮挡性骨吸收,5髋(19.2%)发生2度应力遮挡性骨吸收;主要发生于术后10~24个月,在Gruen 1、7区。双能X线吸收比色法检查示,骨密度减少主要发生在Gruen 1、2、6、7区,骨密度增加主要发生在Gruen 3、4、5区。术后2年后骨密度丢失进展缓慢。术后5~8年骨密度稳定,而8Objective To investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty(THA)with anatomic medullary locking(AML)prosthesis.Methods The clinical data of 24 cases(26 hips)who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed.There were 12 males and 12 females with an age of 32-69 years(mean,53.7 years).There were 5 cases(5 hips)of avascular necrosis of the femoral head,6 cases(7 hips)of secondary osteoarthritis of the hip dysplasia,6 cases(6 hips)of femoral neck fracture,2 cases(2 hips)of primary osteoarthritis,3 cases(3 hips)of revision surgery,1 case(2 hips)of ankylosing spondylitis,1 case(1 hip)of femoral head fracture.The patients were followed up at immediate,6 weeks,3 months,6 months,1 year,and then every year after operation for imaging evaluation(X-ray film was taken immediately after operation to evaluate the femoral isthmus compression,Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis,and Brooker method was used to evaluate the occurrence of heterotopic ossification);bone reconstruction evaluation[reconstruction of prosthesis and bone interface(type of bone reaction,Gruen zone,incidence,and occurrence time were recorded),reconstruction of bone around prosthesis(proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods,and bone mineral density change rate was measured)];clinical efficacy evaluation[Harris score for efficacy,visual analogue scale(VAS)score for thigh pain].Results All patients were followed up 15 years and 2 months to 20 years and 4 months,with a median of 16 years and 6 months.At immediate after operation,24 hips(92.3%)had good femoral isthums compression,24 hips(92.3%)had good bone ingrowth.Heterotopic ossification occurred in 2 patients with degree 1,2 patients with degree 2,and 1 patient with degree 3 at 3-6 months after operation.Hyperplastic bone reactions were more common in Gruen 2,3,4,5,6,10,11,and 12 zones,m

关 键 词：人工全髋关节置换术 髓腔解剖交锁股骨假体 圆柱柄 骨密度 骨改建 

分 类 号：R687.4[医药卫生—骨科学]