变异髋臼初次全髋人工关节置换术前设计及临床意义

Preoperative design and its clinical significance of the first time total hip arthroplasty for the variant acetabular

目的：探讨变异髋臼初次全髋人工关节置换术中髋臼假体的正确放置位置及手术疗效。方法：对34例（38髋）接受全髋关节置换的髋臼变异的各类髋关节疾病进行术前设计，其中男20例，女14例，平均年龄56．1岁（29～75岁）。股骨头坏死继发骨性关节炎15例（19髋），髋臼发育不良继发骨性关节炎12例，创伤性骨关节炎5例，髋关节融合术后1例，髋关节人工股骨头置换术后1例。结果：术后患者均获得随访，平均随访11个月（5～38个月）。根据Harris髋关节功能评分评定，优（〉90分）12髋，良（80～90分）23髋，尚可（70～79分）3髋，失败0髋（〈70分）。评定结果：术前Harris评分平均47．9分，术后平均90．3分。结论：对于髋臼解剖结构异常的髋关节疾病患者行全髋人工关节置换时，通过术前对髋臼正确位置的设计，使髋关节中心置于正确的位置上，既可简化术中操作的难度，又可以使臼杯假体得到牢固固定及良好的骨覆盖，有利于人工全髋关节的长期疗效。

Objective：To study correct position of acetabular prothesis and its effects on operative results of total hip arthroplasty for variant acetabular. Methods：Preoperative design was performed in 34 patients （38 hips） with variant acetabular undergone total hip arthroplasty for the treatment of hip joint diseases. Among them, 20 patients were male and 14 patients were female, ranging in age from 29 to 75 years （ mean 56.1 years）. Among the patients, 15 patients had femoral head necrosis with secondary osteoarthritis, 12 patients had acetabular dysplasia with secondary osteoarthritis, 5 patients had traumatic osteoarthritis, 1 patient underwent fusion of hip joint, and 1 patient underwent artificial femoral head replacement. Reults： Thirty-four patients（38 hips） were followed up from 5 to 38 months, with an average of 11 months. The hip functions were evaluated by Harris score： 12 hips reached excellent results（ 〉90 scores）, 23 hips good （80 to 90 scores）, 3 hips fair （70 to 79 scores） , and no poor （ 〈70 scores）. The mean Harris hip score was 47.9 before operation and 90.3 after operation. Conclusion ： Preoperative design of acetabular correct position, especially correct acetabular center position, can not only reduce operation difficulty in total hip arthroplasty, but also ensure acetabular prothesis obtaining firm fixation and excellent bone, which is benefit to gain excellent long-term therapeutic effects.