全髋表面置换术31例临床分析

Total hip surface replacement arthroplasty:report of 31 cases

目的 探讨全髋关节表面置换术临床疗效，并对影响临床疗效的因素进行分析。方法2000年10月至2005年1月，对3l例37髋股骨头缺血性坏死、骨关节炎、髋发育不良、强直性脊柱炎患者行全髋关节表面置换。其中男15例，女16例；年龄23～65岁，平均42岁。所有患者术前均有手术适应证。手术方法按照Amstutz和Nelson提出的标准方法进行，术后进行定期随访。结果全部患者均获得随访，随访时间3～51个月，平均42个月。患者术后无股骨颈骨折，无脱位，无感染。1例髋臼假体周围发现有透亮带，1例因股骨头假体位置不佳已行翻修。术前平均Harris评分30分，术后为90分，最近一次随访平均评分93分（89～98分）。评价：35髋优，1髋良，1髋差。结论全髋关节表面置换术是治疗年龄较轻股骨头缺血性坏死、骨关节炎、髋发育不良、强直性脊柱炎患者的有效方法，近期随访结果满意。

Objective To introduce the technique of total hip surface replacement, evaluate the early results and review the factors which affect the results. Methods From October 2000 to January 2005, 31 patients （37 hips） with osteonecresis, osteoarthritis, hip dyplasia, ankylosing spendylitis were treated with the total hip surface replacement. Among them, 15 were male, and 16 were female, with an average age of 42 years （range from 23-65years）. All the 31 patients had the indications for hip surface replacement. Standard operation technique which was brought forth by Amstutz and Nelson was employed, and all patients were followed up after operation. Results Patients were followed up for an average period of 42 months （3-51 months）. There were no femoral neck fracture, no dislocaton, no infection in all patients. Radiolucent line existed around acetabular prosthesis in 1 hip and another hip had been revised because the prosthesis of femoral head was in incorrect situation. The average Harris hip score improved significantly from 30 to 90, and the score was 93 in the latest follow-up. Based on Harris system, 35 hips were excellent, 1 hip good , and 1 hip fail. Conclusions The total hip surface replacement is an effective solution for the problem of the patients with osteonecresis of the femoral head, osteoarthritis, hip dyplasia and ankylosing spondylitis. The short-term results are satisfied.