摘要
目的探讨微创小切口人工全髋关节置换术（THA）治疗成人晚期股骨头坏死的适应证与疗效。方法本组45例50髋，平均年龄57．8（41～70）岁。根据世界骨循环研究学会（ARCO）分期，Ⅲ-C期20髋，Ⅳ期30髋。采用后外倒单个小切口，骨水泥型假体15髋，非骨水泥型假体35髋。结果平均随访时间1．8（0.5～3．8）年。平均切口长度8.5（6～10）cm，平均出血量300（100～600）ml，平均输血量110（0～400）ml，平均引流量200（100～400）ml，平均手术时间82（60～110）min。髋臼杯外展角44.2°（40°～55°），股骨偏心距由术前42．5（31．2～50．5）mm增加到45．2（35.2～55.5）mm。X线片上髋臼杯外展角平均44.2°（40°-55°，股骨偏心距由术前平均42.5（31.2-50．5）mm增加到45．2（35．2～55．5）mm。平均术后6（4-12）周弃拐行走。髋关节Harris评分由术前的44分改善为92分。无假体松动、下沉。结论成人晚期股骨头坏死（ARCOⅢ-C期与Ⅳ期）可采用微创小切口THA治疗，创伤小，出血少，康复快，效果好，适合于体格胖瘦适中者。
Objective To explore the clinical effect and indication of the total hip arthroplasty （THA） for late osteonecrosis of femoral head （ONFH） in adult by minimally invasive and mini -incision surgery. Methods Forty -five patients （50 hips） with late ONFH underwent THA. Their ages ranged from 41 to 70 years and a mean was 57.8 years. The mean history was 2.1 years and ranged from 1 to 6 years. There were 20 hips in stage Ⅲ - C and 30 hips in stage Ⅳ according to ARCO method. One mini - incision from posterior - lateral approach was adopted, and the THA was performed by cement less prosthesis in 35 hips and by cement prosthesis in 15 hips. Results All patients were obtained follow - up for 0.5 - 3.8 years with an average of 1.8 years. Their pain was relieved and the function of hips was improved after the operation. The mean incision long was 8.5 cm and ranged from 6 to 10 cm. The mean bleeding volume was 300 ml and ranged from 100 ml to 600 ml. The mean volume of blood transfusion was 110 ml and ranged from 0 ml to 400 ml. The mean volume of drainage after operation was 200 ml and ranged from 100 ml to 400 ml. The mean operative time was 83 min and ranged from 60 min to 110 min. The abduct angle of hip cup ranged from 40° to 55° and a mean was 44.2°. The offset of femur added to 45.2 mm and ranged from 35.2 mm to 55.5 mm after the operation from 42.5 mm and ranged from 31.2 mm to 50.5 mm before the operation. The patients can walk needless crutch at mean time of 6 weeks in 4 to 12 weeks after the operation. The Harris hip score of the function was increased to 92 points post - operative from 44 points pre - operative. Conclusion The late ONFH in adult with the stage in ARCO Ⅲ -c and Ⅳ can be treated by THA of minimally invasive and mini -incision surgery. There was mini - trauma and less bleeding during the operation, and faster healing and well effect after the operation. Its indication is for thin patients.
出处
《中原医刊》
2006年第20期9-11,共3页
Central Plains Medical Journal
关键词
微创
骨坏死
人工全髋关节置换术
Minimally invasive technique
Osteonecrosis
Total hip arthroplasty
