髋关节表面置换术治疗Ficat Ⅲ期股骨头坏死的疗效分析

Surface arthroplasty of the hip for the treatment of Ficat Stage Ⅲ osteonecrosis of the femoral head

目的探讨半髋关节表面置换术和全髋关节表面置换术治疗股骨头缺血性坏死的疗效。方法从1997年6月至2006年7月广西医科大学第一附属医院脊柱骨病科收治的FicatⅢ期股骨头缺血性坏死的患者38例(42髋),患者手术时的年龄29～51岁,平均(37.5±9.2)岁,其中男31例,女7例。其中31例(35髋)行了半髋关节表面置换术,7例(7髋)行了全髋关节表面置换术,所有患者病变部位的术后病理检查均为股骨头缺血性坏死。于术前和随访时采用UCLA髋关节功能评分标准对患者手术前后疼痛、步行、功能、活动进行评分。采用复诊的方式进行随访,于术后2个月开始第1次随访,每年随访1次,共随访1～13年。两组样本间均数比较采用独立样本t检验(并做方差齐性检验)。结果全部患者均获随访,平均8.4年。主要观察指标为:纳入患者髋关节表面置换手术前后UCLA评分的比较;患者半髋和全髋关节表面置换术后疗效的比较。UCLA髋关节功能评分:疼痛、步行、功能、活动的评分由术前的(3.4±1.3)分、(4.8±1.9)分、(5.9±2.8)分、(5.8±2.7)分分别提高到术后的(8.7±2.4)分、(9.0±2.8)分、(8.4±3.3)分、(7.6±3.0)分,两者之间的差异有统计学意义(t值分别为11.48、7.34、3.42、2.64,P<0.01)。其中半髋关节表面置换术35髋术后的满意率为89%,与全髋关节表面置换术7髋术后的满意率相近(100%,2=0.05,P>0.05)。结论半髋关节表面置换术和全髋关节表面置换术是一种可供选择的向全髋关节置换术过渡的较好的治疗方法,可以恢复中FicatⅢ期股骨头缺血性坏死患者的髋关节功能;半髋关节表面置换术和全髋关节表面置换术的中远期疗效是否有差异尚有待进一步观察。

Objective To evaluate the short and middle-term treatment effect of the surface hemi arthroplasty or arthroplasty in treatment of Ficat Stage HI osteonecrosis of the femoral head . Methods Between June 1997 and July 2006, forty-two of the hips which were performed the precision-fit surface hemiarthroplasties or arthroplasties at the first Affiliated Hospital of Guangxi Medical University , including 31 males and 7 females; the averaged age of the patients was（37. 5 ±9. 2） years old （from 29 to 51 years old）. 31 surface hemiarthroplasties （35 hips） and 7 surface arthroplasties （7 hips） were done in 38 patients. The histopathological observation showed femoral head necrosis in all patients. All hips were evaluated with theUniversiLy of California At LosAngeles （UCLA） hip score before and after operation. UCLA scoring Consists of pain, walking, function and activity. The first follow-up was performed two months after operation and then once every years, total was 10 years. Statistical difference was detemined using one way analysis of variance （ANOVA） followeded by StudenLNewman Keuls test. Results Totally 38 patients （42 hips） were involved in the result analysis and follow-up. The main outcome measures were： UCLA hip score before and after operation. Therapic effect of the operation in surface hemiarthroplasties （35 hips） and 7 surface arthroplasties. UCLA hip score： the mean UCLA hip score for the overall group improved sig- nificantly from （ 3.4 ± 1.3 ） to （ 8.7 ± 2. 4 ） points for pain, （4. 8 ± 1.9 ） to （9. 0 ± 2. 8 ） points for walking, （5. 9 ± 2. 8 ） to（ 8.4 ± 3.3 ） points for function, and （ 5.8 ± 2. 7 ） to （7.6 ± 3. 0 ） points for activity （t = 11.48,7.34, 3.42,2. 64 ,P 〈 0. 01 ）. The satisfaction rate was 89% for surface hemiarthroplasties, 100% for Surface arthroplasties. There was not statistical difference between the two stages （X2 = 0. 05, P 〉 0. 05 ）. Conclusion Surface hemiarthroplasty and surface arthroplasty of the hip is a good alterna- tive to total hip arthroplasty that restores hip function for patients with Ficat Stage m osteonecrosis of the femoral head. The difference of the middle-and long-term therapic effect between surface hemiarthroplasty and surface arthroplasty needs to be further investigated.