全髋表面置换术治疗股骨头坏死

Surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis

目的:探讨全髋表面置换术治疗股骨头缺血性坏死的疗效和适应证。方法:回顾性分析17例(21髋)股骨头缺血性坏死患者的临床资料。其中男10例,女7例;年龄25～51岁,平均36岁。其中FicatⅢ期8髋,FicatⅣ期13髋。均行金属全髋表面置换术。取Gibson后外侧切口,采用非骨水泥型假体。处理股骨头时,以颈干角通过股骨头中心打入1根导针,用空心钻头钻孔后插入导引杆,再用圆柱形的股骨头切割器锉去股骨头的多余部分,在股骨头上钻孔,将骨水泥涂抹在股骨头和假体上,将假体柄插入股骨颈中心轴骨孔内,冲紧到位,等待骨水泥固化。术后Harris评分分析,并进性统计学分析(t检验),定期复查X线片。结果:全部病例均获得随访,随访时间18～42个月,平均32个月。髋关节功能Harris评分由术前的平均(35.30±5.23)分提高到术后(90.47±3.14)分,优良率90.5%,手术前后Harris评分差异有统计学意义(P<0.01)。X线摄片发现2例髋臼假体周围出现透亮线,而无松动迹象。结论:全髋表面置换术是治疗中晚期股骨头缺血性坏死的理想方法,它能恢复正常的关节生物力学及负载传递,提高了关节的稳定性,延缓了全髋关节置换,不影响日后的翻修效果,且创伤小、操作简便、感染率低。适用于FicatⅢ期及部分FicatⅣ期的股骨头坏死,股骨颈破坏少,特别是活动量大的年轻患者。

Objective： To evaluate the outcome and indication of surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis. Methods：The clinical data of 17 patients （21 hips）with femoral head osteonecrosis were reviewed. Among which, 10 cases were male and 7 cases were female,the average age was 36 years old （ranging from 25 to 51 years）. There were 8 hips at Ficat stage ill and 10 hips at Ficat stage IV. The 17 patients（21 hips）underwent sur- face-replacement total hip arthroplasty. Gibson posterolateral incision was used and non-cemented prosthesis was implanted. For prosthetic femoral head fixation, a guide pin was inserted into the capital center. After hollow boring bit drilling, a guide pole was inserted ,and redundancy of femoral head was rasped off with cutterbar. The bone cement was painted on the femoral head and prosthesis,and the prosthesis was planted into the central axis hole of neck of femur untill bone cement solidification. The therapeutic effects were evaluated by Harris hip score and statistical analysis was made. The X-ray was rechecked regularly. Results：The mean duration of follow-up was 32 months （18 to 42 months）. The average Harris hip score was improved significantly from preoperative 35.30±5.23 to postoperative 90.47±3.14 ,and the excellent and good rate was 90.5%. There were high statistical differences between preoperative and postoperative Harris score（P〈0.01 ）. The X-ray showed radiolucent line around acetabular prostheses in two patients but without prostheses loosening. Conclusion ：Surface- replacement total hip arthroplasty is a satisfactory way for the treatment of femoral head osteonecrosis in the middle-late phase,which can help reconstructing normal joint biomechanics and load transmission,improving joint stability and postponing THA without affecting later rebuilding, as well as some advantages such as decreasing surgical wound ,convenient and low infection rate. Its indication is Ficat stage Ⅲ and part Ficat stage Ⅳ femur head necrosis with less destroyed neck of femur,especially for young patients having a large amount of activity.