对不同Paprosky分型股骨缺损全髋关节翻修术后肢体长度差异的分析  

Analysis of leg length discrepancy in patients with different Paprosky types femur bone defect after hip revisions

作　　者：徐海军 胡家朗 熊文[1] 陈明 勘武生[1] Xu Haijun;Hu Jialang;Xiong Wen;Chen Ming;Kan Wusheng(Department of Orthopedics,Wuhan Fourth Hospital,Wuhan 430033,China)

机构地区：[1]湖北省武汉市第四医院骨科,430033

出　　处：《骨科临床与研究杂志》2023年第3期160-163,共4页Journal Of Clinical Orthopedics And Research

基　　金：湖北省武汉市卫生计生委青年项目(WX17Q23)。

摘　　要：目的分析Paprosky I型、II型和IIIA型3种股骨骨缺损患者术前及使用一体型股骨柄翻修术后下肢不等长(LLD)的改善情况。方法2009年1月至2016年1月于湖北省武汉市第四医院骨科使用一体型Wagner SL股骨柄行髋关节翻修获得5年及以上随访的患者58例(58髋);其中男15例,女43例;年龄29~91(68.3±8.9)岁。根据术前及术中的情况,确定骨缺损的分型。根据股骨侧缺损情况将病例分为3组,分别为PaproskyⅠ型(Ⅰ组)、PaproskyⅡ型(Ⅱ组)、PaproskyⅢA型(Ⅲ组)。患者复查随访包括临床功能评分、影像学检查、Harris评分。通过与患者术后影像学资料对比,评估假体的固定情况,测量双下肢肢体长度。结果随访时间为5~10(7.6±1.6)年。患者术前Harris评分为(44.5±14.0)分;术后Harris评分为(86.6±6.2)分(P<0.05)。Ⅰ组为17例;Ⅱ组为32例;Ⅲ组为9例。3组之间年龄、体质指数、术前和术后Haris评分等差异无统计学意义。3组术前LLD及两两比较差异均有统计学意义;分别为Ⅰ组(1.38±0.78)cm;Ⅱ组为(1.84±0.81)cm;Ⅲ组为(2.68±1.19)cm。3组术后LLD及两两比较差异均无统计学意义。结论随着Paprosky股骨骨缺损的逐级增加,LLD也逐渐增加。Wagner SL用于处理PaproskyⅠ型、Ⅱ型及ⅢA型股骨缺损可以获得良好的中期效果,肢体长度也得到较好平衡。Objective To analyze the leg length discrepancy(LLD)in patients with Paprosky typeⅠ,typeⅡand typeⅢA femur defect before surgery and after revisions by monobloc femoral stems.Methods From January 2009 to January 2016,58 patients(58 hips)were followed up for 5 years or more in Department of Orthopedics,Wuhan Fourth Hospital,who underwent hip revisions with Wagner SL femoral stems.There were 15 males and 43 females.The age of the patients was 29-91(68.3±8.9)years.The classification of bone defects was determined according to the preoperative and intraoperative conditions.According to the defect of femoral side,the cases were divided into three groups:Paprosky TypeⅠ,Paprosky TypeⅡ,and Paprosky TypeⅢA.Clinical functions,images and Harris scores were recorded.By comparing with the patient's postoperative imaging data,fixation of the prosthesis was evaluated and the length of both lower limbs was measured.Results The follow-up time was 5-10(7.6±1.6)years.The preoperative Harris score was 44.5±14.0,and the postoperative Harris score was 86.6±6.2,the difference was statistically significant(P<0.05).The patients were divided into three groups according to bone defect of femoral side:Paprosky typeⅠ(17 cases),Paprosky typeⅡ(32 cases),and Paprosky typeⅢA(9 cases).There were no significant differences in age,BMI,preoperative Harris score and postoperative Haris score among the three groups.There were statistically significant differences in preoperative LLD among the three groups,as well as pairwise comparisons,which were(1.38±0.78)cm in groupⅠ,(1.84±0.81)cm in groupⅡand(2.68±1.19)cm in groupⅢrespectively.There was no significant difference in postoperative LLD between the three groups,nor was there any significant difference in pairwise comparison.Conclusion LLD increased gradually with the increase of Paprosky femoral bone defects.Revision with Wagner SL stem for Paprosky typeⅠ,Ⅱ,andⅢA bone defects can achieve good results and achieve great balance of limb length.

关 键 词：关节成形术 置换 髋 假体和植入物 肢体长度差异 

分 类 号：R687.4[医药卫生—骨科学]