生物型人工全髋关节置换术治疗股骨近段畸形合并终极髋关节疾病

CLINICAL RESULTS OF UNCEMENTED TOTAL HIP ARTHROPLASTY FOR ULTIMATE HIP DISEASE COMBINED WITH PROXIMAL FEMORAL DEFORMITY

目的 探讨生物型人工全髋置换术（total hip arthroplasty,THA）联合截骨矫正术治疗股骨近段畸形合并终极髋关节疾病的临床疗效。方法 2005年2月-2013年6月,采用生物型THA联合截骨矫正术治疗48例（51髋）股骨近段畸形合并终极髋关节疾病患者。男14例（16髋）,女34例（35髋）;年龄19～83岁,平均52岁。单髋45例,双髋3例。髋关节发育不良36例（39髋）创伤性关节炎3例（3髋）,既往有股骨转子间外翻截骨手术史1例（1髋）,股骨近端骨折内固定失败4例（4髋）,陈旧性髋关节结核3例（3髋）,陈旧性化脓性感染1例（1髋）。Trendelenburg征均呈阳性,19例双下肢不等长。畸形位于股骨大转子4髋,股骨颈39髋,股骨干骺端7髋,股骨干1髋。髋关节功能Harris评分为（34.28±3.28）分。结果 术后患者切口均Ⅰ期愈合。1例发生下肢深静脉血栓形成,无感染、神经血管损伤以及脱位等并发症发生。47例（50髋）获随访,随访时间1～9年,平均3.8年。末次随访时,髋关节功能Harris评分改善至（92.87±4.57）分,与术前比较差异有统计学意义（t=—213.19,P=0.00）。6髋Trendelenburg征阳性,其余均为阴性。42髋步态恢复正常,8髋存在轻度跛行。X线片示畸形完全矫正,截骨区均获骨性愈合,愈合时间3～6个月,平均4.4个月;末次随访时股骨及髋臼假体均获骨长入性固定;股骨假体周围Gruen 1、7区呈局限性骨溶解者2例,髋臼假体周围未发现骨溶解,无假体松动。结论 采用生物型THA联合截骨矫正术治疗股骨近段畸形合并终极髋关节疾病,可获得满意疗效。

Objective To evaluate the clinical results of uncemented total hip arthroplasty （THA） for ultimate hip disease combined with proximal femoral deformity. Methods Between February 2005 and June 2013, 48 cases （51 hips） of ultimate hip disease combined with proximal femoral deformity were treated with uncemented THA and osteotomy. There were 14 males （16 hips） and 34 females （35 hips）, with an average age of 52 years （range, 19-83 years）. Unilateral hip was involved in 45 cases, and bilateral hips in 3 cases. There were 36 cases （39 hips） of developmental dysplasia of hip, 3 cases （3 hips） of traumatic arthritis, 1 case （1 hip） of previous intertrochanteric valgus osteotomy, 4 cases （4 hips） of internal fixation failure, 3 cases （3 hips） of tuberculosis, and 1 case （1 hip） of suppurative infection. Preoperative Trendelenburg sign was positive in all hips. The discrepancy of limbs was observed in 19 patients. According to Berry classification system, deformity located at the greater trochanter in 4 hips, at the femoral neck in 39 hips, at the femur metaphysis in 7 hips, and at femoral shaft in 1 hip. The Harris score was 34.28~3.28 before operation. Restdts Healing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and no complications of infection, neurovascular in）ury, or prosthetic dislocation were found. Forty-seven patients （50 hips） were followed up 3.8 years on average （range, 1-9 years）. At last follow-up, the Harris hip score was 92.87±4.57, showing significant difference when compared to preoperative score （t= -213.19, P=0.00）. Postoperative Trendelenburg sign was positive in 6 hips. Normal gait was shown in 39 cases, and slight limp in 8 cases. X-ray film results showed completecorrection of deformity and bony fusion at the osteotomy sites at 3 to 6 months （mean, 4.4 months） after operation. At last follow-up, all the femoral and acetabulum components showed radiographic evidence of bone ingrowth. Osteolysis was observed in Gruen zones 1 and 7 around the femoral prosthesis of 2 cases. There was no case of prosthesis loosening. Conclusion The biological fixation of the femoral stem prosthesis combined with corrective osteotomy can attain satisfactory result for ultimate hip disease combined with proximal femoral deformity in THA.