精确匹配的半髋表面置换术治疗股骨头缺血性坏死的临床和X线分析(英文)

Precision-fit surface hemiarthroplasty of the hip for the treatment of the femoral head osteonecrosis:clinical and radiological results

目的评价精确匹配的半髋表面置换术治疗股骨头缺血性坏死的疗效。方法41例(48髋)金属半髋表面置换术患者手术时的平均年龄为36.7岁,随访至少3年或直到假体失败。所有的患者均诊断为股骨头缺血性坏死:FicatIII期35髋,FicatIV期13髋;其中自发性占7.3%,创伤性占9.7%,酒精性占22%,激素性占61%;他们的髋臼相对正常。在术后骨盆的X线片上测量股骨假体的插入角度和下沉程度。结果全部病例均获随访,平均5.7年。平均的UCLA髋关节功能评分明显改善(P=0.001),疼痛由术前的3.1分提高到9.0分;步行由4.4分提高到9.1分;活动由5.5分提高到7.0分。按UCLA评分标准,FicatIII期35髋术后的满意率为88.6%;FicatIV期13髋术后的满意率为69.2%(P=0.25)。8个髋的疗效差,UCLA髋关节功能评分无明显改善,术后X线检查发现7个髋呈髋内翻植入了假体(插入的短柄与股骨轴线的夹角均小于130°);6例假体头中心的平均下沉为5.0mm。假体的5年生存率为83%。结论在严格掌握手术适应证、提高手术技术的前提下,精确匹配的半髋表面置换术治疗股骨头缺血性坏死的疗效满意;对于髋关节表面置换,处于外翻位置的股骨假体更可取。

[Objective] To evaluate the outcome of Precision-fit Surface Hemiarthroplasty in treatment of the femoral head osteonecrosis. [Methods] We reviewed the results of forty-eight Precision-fit Surface Hemiarthroplasties in patients who were forty years old or younger at the time of the operation and were followed for a minimum of three and half years or until the prosthesis failed. All of patients were diagnosed femoral-head necrosis with thirty- five at Ficat stage Ⅲ and thirteen at early stage Ⅳ： idiopathic （7.3%）, traumatic （9.7%）, alcoholic （22%） and steroid-induced （61%）; their acetabula were relatively normal. Measurements of the hip reconstruction were made on the anteroposterior pelvic radiograph： the orientation of the femoral component and the migration of an implant. [Results] The mean duration of follow-up was 5.7 years. The average UCLA hip score at follow-up was improved significantly from 3.1 to 9.0 points for pain, 4.4 to 9.1 points for walking, and 5.5 to 7.0 points for activity （P=0.001）. The satisfaction rate was 88.6% for thirty-five at Ficat stage III, 69.2% for thirteen at Ficat stage IV （P=0.25）. Eight hips failed; their UCLA hip scores were not improvetl significantly; the postoperative X-ray examination showed that 7 femoral prostheses were implanted in a varus orientation （the angle .between the femoral prosthesis stem and the anatomic axis of the femoral shaft was lower than angle of 130°）, 6 of which had a significant migration with the average of 5.0 mm. Five-year survival rate of the prosthesis was 83%. [Conclusions] Precision-fit Surface Hemiarthroplasty of the hip had a satisfactory result in treatment of the femoral head osteonecrosis on the basis of observing strictly operative indications and improving operative technique; Optimizing the implantation angle toward a valgus orientation during the preparation of the femoral head is important for surface arthroplasty.