摘要
目的探讨人工髋关节表面置换术（hip resurfacing arthroplasty,HRA）治疗年龄〈60岁中青年股骨头坏死患者的临床疗效。方法 2008年1月-2009年4月采用HRA治疗股骨头坏死患者34例,其中男19例,女15例;左髋16例,右髋18例;年龄33~59岁,平均54岁。病因：酒精性9例,激素性8例,创伤性7例,不明原因10例。病程2~11年,平均5年。股骨头坏死改良Ficat分期为Ⅲ期26例,Ⅳ期8例。采用Harris髋关节评分系统（Harris hip score,HHS）和改良加州大学洛杉矶分校（UCLA）活动评分评估患者临床效果;术后摄X线片评估假体位置及是否发生松动,并测量臼杯外展角、颈干角和股骨假体-股骨外侧皮质长度比判断术后有无股骨头假体塌陷。结果术后患者切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓形成等术后早期并发症发生。32例患者获随访,随访时间70~84个月,平均78个月。随访期间均无假体松动、感染、股骨颈骨折、脱位及炎性假瘤等并发症发生。末次随访时患者HHS评分和改良UCLA活动评分分别为（95.22±1.47）、（7.70±1.13）分,均显著优于术前的（50.10±2.27）、（3.90±0.90）分,比较差异均有统计学意义（t=1.510,P=0.008;t=0.830,P=0.003）。术后3 d与末次随访时比较患者臼杯外展角、颈干角及股骨假体-股骨外侧皮质长度比,差异均无统计学意义（P〉0.05）。结论严格掌握手术指征,HRA可作为治疗中青年FicatⅢ期或Ⅳ期股骨头坏死患者的有效方法。
Objective To evaluate the clinical and radiographic outcomes of hip resurfacing arthroplasty（HRA） for treating osteonecrosis of the femoral head（ONFH） in young and middle-aged patients. Methods Between January 2008 and April 2009, 34 patients with ONFH underwent HRA. There were 19 males and 15 females with an average age of 54 years（range, 33-59 years）. Of 34 cases, 16 left hips and 18 right hips were involved, including 9 cases of alcoholinduced ONFH, 8 cases of steroid-induced ONFH, 7 cases of traumatic ONFH, and 10 cases of unexplained ONFH. According to modified Ficat classification system, 26 hips were rated as stage III, and 8 hips as stage IV. The Harris hip score（HHS） and modified University of California, Los Angeles（UCLA） activity score were used to evaluate the clinical results. Migration of prosthesis was assessed on the anteroposterior radiographs. The abduction angle was measured on the acetabular side. On the femoral side, varus-valgus shift was determined by measurement of stem-shaft angle. The axial collapse of femoral component was assessed with the component-lateral cortex ratio. Results Healing of incision by first intention was achieved in all patients without complications of infection and thrombosis of deep vein of lower extremities. Thirty-two patients were followed up 78 months on average（range, 70-84 months）. No implant loosening, infection, femoral neck fracture, dislocation, and inflammatory pseudotumor were observed. At last follow-up, the HHS score was significantly increased to 95.22±1.47 from preoperative 50.10±2.27（t=1.510, P=0.008）. Modified UCLA activity score was significantly increased to 7.70±1.13 from preoperative 3.90±0.90（t=0.830, P=0.003）. The abduction angle, stemshaft angle, and compotent-lateral cortex ratio showed no significant difference between at 3 days after operation and last follow-up（P〈0.05）. Conclusion If the indication of operation is mastered strictly, HRA may be effective in treatment for ONFH at Ficat stage III or
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第2期133-137,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81371979)~~
