双克氏针单平面导向截骨法在僵硬、强直髋关节置换术中的应用

Application of single plane-guided osteotomy with double Kirschner needle in rigid and ankylosis hip arthroplasty

目的评价双克氏针单平面导向法截骨在僵硬、强直髋关节置换术中一次截骨的准确性和安全性。方法2008-01至2022-06,在武警江苏总队医院采用全髋关节置换术治疗强直性脊柱炎(AS)髋关节骨性强直12例(24髋),僵硬髋23例(36髋)。均行后外侧入路,在股骨颈第一次截骨过程中,利用双克氏针单平面导向法截骨,在股骨颈上方,大粗隆外侧,向小粗隆上方1.5~2.0 cm处置入2.5 mm的克氏针2枚,透视调整克氏针组成的平面平行髋臼前倾的角度,避免损伤髋臼的前壁,剪短克氏针不影响摆锯工作,沿克氏针下缘锯断股骨颈完成第一次截骨。对髋关节强直和僵硬髋,按红细胞沉降率(ERS)30 mm/h为界分为两亚组,统计术后髋关节屈髋角度、内收外展角度和、残留曲髋畸形及手术前后Harris功能评分。结果所有患者均一次完成精准截骨,无髋臼前后壁损伤,随访时间50~86个月,平均63.8个月。术后Harris评分较术前提高(P<0.05),髋关节活动度改善(P<0.05);异位骨化6例,其中Brooker Ⅰ 4例,Brooker Ⅱ 2例。末次随访均未出现臼杯松动。结论双克氏针单平面导向截骨法在强直、僵硬髋关节置换中操作简单,可避免髋臼前壁损伤、大粗隆截骨的相关并发症,是引导股骨颈第一次截骨的有效方法。

Objective To evaluate the accuracy and safety of single plane-guided osteotomy with double Kirschner needle in rigid and ankylosis hip arthroplasty.Methods From January 2008 to June 2022,total hip arthroplasty was used in the treatment of ankylosing spondylitis(AS)in 12 cases(24 hips)with hip rigidity and 23 cases(36 hips)with hip rigidity in Jiangsu Provincal Corps Hospital of Chinese People’s Armed Police Force.The posterolateral approach was performed.During the first osteotomy of the femoral neck,two 2.5 mm Kirschner needles were inserted into the femoral neck,lateral to the greater trochanter,1.5~2.0 cm above the lesser trochanter,and the angle of the plane of Kirschner needles parallel to the acetabulum was adjusted by fluoroscopy to avoid damage to the anterior wall of the acetabulum.The first osteotomy was completed by cutting the neck of the femur along the lower edge of the Kirschner needle without affecting the work of the swinging saw.Hip ankylosis and stiffness were divided into two subgroups according to the boundary of ESR value of 30 mm/h.Hip flexion angle,adduction and abduction angle,residual hip flexion deformity and Harris function score before and after surgery were analyzed.The postoperative hip flexion angle,adduction and abduction angle,residual hip flexion deformity and Harris function score before and after surgery were analyzed.Results Intraoperative precise osteotomy was completed without anterior and posterior wall injuries of acetabulum.All patients were followed up for an average of 63.8 months(range,50-86 months).The postoperative Harris score was higher than that before surgery(P<0.05),and the range of hip motion was improved(P<0.05).There were 6 cases of heterotopic ossification,including 4 cases of Brooker Ⅰ and 2 caes of BrookerⅡ which were asymptomatic and untreated.At the last follow-up,there was no loosening of the acetabular cup.Conclusions Single planeguided osteotomy with double Kirschner needle is an effective method for ankylosis and rigid hip arthroplasty,which is simple to operate and can avoid the injuries of the anterior wall of the acetabulum and the complications related to the osteotomy of the greater trochanter.