全髋关节置换术治疗大骨节病髋关节病变的早期疗效评价及翻修经验  

Evaluation of early outcomes and discussion of revisions of total hip arthroplasty in treatment for Kashin-Beck disease with hip problem

作　　者：吴昊天 张校源 李晖[1] 柯岩[1] 王锴[1] 邢丹[1] 李志昌[1] 林剑浩[1] Wu Haotian;Zhang Xiaoyuan;Li Hui;Ke Yan;Wang Kai;Xing Dan;Li Zhichang;Lin Jianhao(Arthritis Clinic and Research Centre,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院关节病诊疗中心,北京100044

出　　处：《中华骨科杂志》2025年第6期335-342,共8页Chinese Journal of Orthopaedics

基　　金：国家重点研发计划(2022YFC2503103)。

摘　　要：目的探讨全髋关节置换术(total hip arthroplasty,THA)治疗晚期大骨节病(Kashin-Beck disease,KBD)髋关节病变的早期疗效及翻修经验。方法回顾性分析2019年10月至2024年1月于北京大学人民医院关节病诊疗中心行THA的50例(64髋)KBD髋关节病变的患者资料,男25例、女25例,年龄(52.4±8.7)岁(范围29~70岁),左侧36髋、右侧28髋。于术前及末次随访时记录髋关节总活动度、Harris评分,手术前后通过髋关节正位X线片测量双下肢长度差(leg length discrepancy,LLD)和股骨偏心距(femoral offset,FO),术后1周测量髋臼外展角、前倾角,比较手术前后的影像指标,比较术前及末次随访的功能指标,统计并发症及假体翻修术情况。结果50例均顺利完成手术,手术时间为105(80,120)min,术中出血量为300(200,400)ml,随访时间为37(21,44)个月。术后LLD为(0.50±0.78)cm、FO为(3.28±1.01)cm,分别较术前的(-1.36±0.79)cm、(2.72±0.83)cm改善,差异有统计学意义(P<0.05);术后髋臼外展角为42.5±7.7°,前倾角为15.1±5.9°。末次随访时髋关节总活动度为185°(173°,210°)、Harris评分为70(63,80)分,较术前的99°(76°,123°)、35(26,43)分改善,差异有统计学意义(P<0.05)。术后股骨柄松动2例、股骨柄周围骨折1例、髋关节脱位1例、髋臼松动并髋关节半脱位1例及臀中肌步态7例。随访期间共5例髋关节接受了假体翻修术,翻修原因分别为股骨柄松动2例、股骨柄周围骨折1例、髋关节脱位1例、髋臼松动并髋关节半脱位1例。结论THA治疗KBD髋关节病变术后早期影像及功能指标得到改善。ObjectiveTo evaluate the early outcomes of total hip arthroplasty(THA)and discuss the revisions post THA in the treatment for Kashin-Beck disease(KBD)with severe hip problems.MethodsThis retrospective cohort study enrolled 50 patients(64 hips)with a mean age of 52.4±8.7 years,including 25 male patients and 25 female patients(36 left hips and 28 right hips),who were diagnosed as KBD with hip problems and received THA at Arthritis Clinical and Research Centre,Peking University People's Hospital from October 2019 to January 2024.The leg length discrepancy(LLD),femoral offset(FO),abduction angle and anteversion angle were calculated preoperatively and one week post-operation.The postoperative radiological indexes and the functional outcomes in the last follow-up were compared with the preoperative assessment.ResultsThe surgical duration was 105(80,120)min and the bleeding amount was 300(200,400)ml.All the cases were followed up for an average of 37 months(ranging from 21 to 44 months).Significant differences were found on postoperative radiological images,with LLD improving to 0.50±0.78 cm from a preoperative value of-1.36±0.79 cm,and FO increasing to 3.28±1.01 cm from 2.72±0.83 cm(P<0.05).The mean postoperative abduction angle and anteversion angle were 42.5°±7.7°and 15.1°±5.9°,respectively.A total of 71.8%and 95.3%hips fell within the Lewinnek safe zones of abduction angle and anteversion angle,respectively.In terms of functional outcomes,the average range of motion improved significantly to 185°(173°,210°)from a preoperative value of 99°(76°,123°),and the Harris Hip Score increased from 35(26,43)preoperatively to 70(63,80)postoperatively(P<0.05).During the follow-up,there were complications for two cases of femoral stem loosening,one case of periprosthetic femoral fracture,one case of hip dislocation,and one case of acetabular component loosening with hip subluxation.Additionally,seven patients exhibited Trendelenburg gait.A total of five hips required revision surgery due to severe complications,

关 键 词：地方性关节病 大骨节病 关节成形术 置换 髋 假体翻修 

分 类 号：R687.4[医药卫生—骨科学]