非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形  

Total hip arthroplasty without femoral shortening osteotomy for end-stage arthrosis complicated with femoral head and neck shortening deformity

作　　者：王兴科 乔永杰 甄平 周胜虎 余新愿 张浩强 WANG Xing-ke;QIAO Yong-jie;ZHEN Ping;ZHOU Sheng-hu;YU Xin-yuan;ZHANG Hao-qiang(Department of Orthopaedics,People's Hospital of Gulang County,Gulang 733100,China;Department of Orthopedic Surgery,The 940^(th)Hospital,Joint Logistic Support Force of PLA,Lanzhou 730000,China)

机构地区：[1]甘肃省古浪县人民医院骨科,甘肃古浪733100 [2]解放军联勤保障部队第九四〇医院骨关节外科,甘肃兰州730000

出　　处：《中国矫形外科杂志》2023年第5期446-449,共4页Orthopedic Journal of China

基　　金：甘肃省青年科技基金项目(编号:20JR5RA588,21JR7RA014)。

摘　　要：[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对19例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路,先切开并松解粘连挛缩的髋关节囊,充分显露髋臼,确定真性髋臼位置并行髋臼成形或再造,安放髋臼假体;适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位,在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解,随后置入适配的股骨柄及股骨头假体,复位髋关节。[结果]19例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定,无严重并发症。术后随访6~36个月。术后6个月随访时患者Harris评分为(94.5±4.7)分,临床效果评定:优15例、良4例,优良率100%。术后影像显示所有患者均保持解剖位旋转中心,假体位置良好,术后3个月X线片均示广泛性骨长入,随访期间均未发生脱位、假体柄移位及断裂。[结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行,短期疗效满意。[Objective]To introduce the surgical technique and preliminary clinical results of total hip arthroplasty(THA)without femoral shortening osteotomy for end-stage arthrosis complicated with femoral head and neck shortening deformity.[Methods]A total of 19 patients received THA for end-stage hip arthrosis complicated with femoral head and neck constriction deformity.A posterolateral approach was used to expose the hip complicated with severe deformity.Identifying the location of the true acetabulum,the poorly developed acetabulum was reconstructed with autologous femoral head,reamed and then implanted with the acetabular components in proper position.After contracted soft tissues around the joint were released successively,the proximal femur was prepared and inserted with femoral stem in proper size.After trial,the femoral head component in suitable length was installed,and the joint was reduced with proper stability and motion.[Results]All the 19 patients had THA performed successfully with good initial stability of acetabulum and femoral components without serious complications,and followed up for 6 to 36 months.Six months after the operation,the Harris score was of(94.5±4.7),while the clinical outcome was graded as excellent in 15 cases and good in 4 cases,with an excellent and good rate of 100%.In term of imaging,all the patients maintained the hip center of rotation in anatomic position,and had prosthesis in proper position,got obvious bone ingrowth of the prosthesis 3 months after surgery,without dislocation,stem displacement or fracture during follow-up.[Conclusion]Total hip arthroplasty without femoral shortening osteotomy is feasible technique for treatment of end-stage arthrosis complicated with femoral head and neck shortening deformity,does achieve satisfactory short-term clinical outcome.

关 键 词：终末期髋关节病 股骨头颈短缩畸形 全髋关节置换术 非股骨短缩截骨 软组织松解 

分 类 号：R687.4[医药卫生—骨科学]