摘要
【目的】探讨全髋关节表面置换术治疗成人髋关节发育不良继发骨关节炎的疗效、安全性和有效性。【方法】2005年5～6月，对12例成人髋关节发育不良继发骨关节炎患者13个髋关节进行全髋关节表面置换术。男性4例，女性8例；年龄30～59岁，平均47岁，所有患者均为半脱位型。髋臼侧采用真臼位置重建，为非骨水泥固定，股骨头假体采用骨水泥固定。【结果】手术时间平均110min，术中失血平均387ml，术后引流量平均200ml，肢体延长平均9mm（术前短缩平均14mm）。所有患者切口均一期愈合，无感染、股骨颈骨折、脱位、松动、神经血管损伤等并发症。全部随访12～13个月，临床效果满意，平均髋关节活动度屈曲由106．7°增加到120°，外展由25．8°增加到46．4°，外旋由20．8°增加到45°，内旋由3．3°增加到28．6°，Harris评分由术前的平均42分增加到术后的平均96分。X线片显示关节假体位置正常，人工髋臼平均外展角为39°，股骨头中心柄与股骨干夹角平均141°，髋关节旋转中心位置平均下移9mm，内移11．5mm。宿主骨对臼杯的平均覆盖率为89．5％，宿主骨与假体之间未见透亮线。【结论】全髋关节表面置换术治疗半脱位型的成人髋关节发育不良继发骨关节炎患者具有良好的近期疗效和应用前景，其远期疗效及其他类型髋关节发育不良患者的应用还需进一步研究。
[Objective] To evaluate the safety and efficacy of total hip resurfacing arthroplasty in treating osteoarthritis secondary to congenital dysplastic hip. [Method] From May 2005 to June 2005, 13 hips in 12 cases with osteoarthritis secondary dysplastic hip were adopted in this study. There were 8 females and 4 males, aged from 30 to 59 years, average 47 years. All the 13 hips were subluxation according to Hartofilakidis classification system. Posterolateral approach was used during operation and all the acetabular cups were reconstructed at the true acetabular location. The pronthesis were cementless acetabular cup and cement femoral head. [ Result ] The average operation time was 110 min, blood loss volume was 387 ml during operation, drainage volume was 200 ml and the extremity was lengthened for about 9 mm. All the incision healed well and there have not any complications such as femoral neck fracture, infection, dislocation and neurovascular injury. Follow-up for 12 to 13 months, all the joints had good or excellent clinical results. The average range of motion of the hip： flexion improved from 106. 7° to 120°, abduction improved from 25. 8° to 46. 4°, external rotation improved from 20. 8° to 45°, internal rotation improved from 3. 3° to 28. 6°. The Harris score increased from 42 preoperatively to 96 postoperatively. Radiographically, the positions of the prostheses were normal, the average abduction angle of the cup was 39°, the average stem-shaft angle wes 141°, the positions of acetabular rotation centre were moved down and medially for average 9 mm and 11.5 mm respectively, the acetabular superolateral bone coverage of the hips was 89.5% , no radiolucent line was observed. [ Conclusion] Total hip resurfacing arthroplasty has got good short-term results in the treatment of osteoarthritis secondary to dysplastic hip. Because of the less quantity and short follow-up time, the long-term results and indications for other kinds of dysplastic hip are worthy of further studying.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2006年第23期1787-1791,共5页
Orthopedic Journal of China
