摘要
[目的]探讨改良股骨大转子滑移截骨术治疗初次全髋关节置换股骨近端严重畸形的可行性、围手术期并发症及早期随访疗效。[方法]回顾性分析2015年1月~2017年1月,采用改良股骨大转子滑移截骨术联合近端固定型非骨水泥股骨假体柄对30例股骨近端严重畸形的患者行初次全髋关节置换,5例为双侧,术前X线片示所有患者均有双下肢不等长、股骨近端髓腔发育不良、旋转或成角畸形以及股骨大转子上移,并对髋关节功能、双下肢不等长、术后并发症及假体生存率进行临床及影像学评估。[结果]截止最近一次随访,术后所有患者步行能力和疼痛均有明显改善,术前35例髋Trendelenburg征均阳性,术后仅3例阳性。切口均Ⅰ期愈合,截骨端均骨性愈合。术前Harris评分为(38.18±5.24)分,术后3个月Harris评分改善至(82.87±4.45)分,差异有统计学意义(t=-15.768,P<0.001)。术前双下肢不等长(4.15±1.06)cm,术后1 d双下肢不等长(0.73±0.32)cm,差异有统计学意义(t=4.487,P=0.002)。[结论]改良股骨大转子滑移截骨术恢复了臀中肌张力,重建了股骨侧生理偏心距及前倾角,恢复了下肢相对长度及软组织张力,减少截骨后骨折不愈合的风险,股骨柄初始稳定性良好,是治疗股骨近端畸形的有效术式之一。
[Objective] To explore the feasibility,complication and early outcomes of modified sliding osteotomy of femoral greater trochanter for severe proximal femoral deformity in primary total hip replacement.[Methods] A retrospective study was done on 30 patients（35 hips） who underwent primary THA with modified sliding osteotomy of remoral greater trochanter and uncemented proximal fixation femoral prosthesis stem from January 2015 to January 2017.Of them,5 patients had bilateral hip arthroplasty performed separately.Before operation,all the 30 patients showed in radiographs serious anatomic abnormalities,including dysplasia of proximal femoral medullary cavity,the rotation or angulation deformities of proximal femur and the proximal displacement of femoral greater trochanter,accompanied with the limbs length discrepancy.The function of hip joints,inequality of lower extremities,postoperative complications and radiographic changes were evaluated.[Results] All patients experienced substantial improvement in walking capacity and pain relief at the latest follow-up.The positive Trendelenburg test significantly decreased from 35 hips preoperatively to only 3 hips postoperatively.All the 35 hips got bony healing of osteotomy fragments at the latest follow up.The Harris scores significantly increased from（38.18±5.24） preoperatively to（82.87±4.45） at3 months postoperatively（P0.001）.The side to side length differences of the low extremities significantly reduced from（4.21±2.92） cm preoperatively to（0.73±0.32） cm postoperatively（P0.05）.[Conclusion] Modified sliding osteotomy of femoral greater trochanter in primary total hip arthroplasty is an effective surgical treatment for severe proximal femoral deformity with advantages of rebuilding femoral offset and anteversion,restoring abductor tension and relative low limb length,and providing reliable primary fixation and rotational stability,while decreasing the likelihood of nonunion.
作者
朱晨
尚希福
孔荣
方诗元
吴科荣
马锐祥
陈敏
罗正亮
李乾明
周华骏
ZHU Chen;SHANG Xi-fu;KONG Rong;FANG Shi-yuan;WU Ke-rong;MA Rui-xiang;CHEN min;LUO Zheng-liang;LI Qian-ming;ZHOU Hua-jun(Department of Orthopaedics,the First Affiliated Hospital,University of Science and Technology of China,Hefei 230001,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第17期1537-1543,共7页
Orthopedic Journal of China
基金
国家自然科学基金项目(编号:81401815)
中国博士后科学基金项目(编号:2015M582900)
江苏省博士后科学基金项目(编号:1501146C)
关键词
全髋关节成形术
股骨大转子
截骨
股骨近端
畸形
total hip arthroplasty （THA）
greater trochanter
osteotomy
proximal femur
deformity
