混合型人工全髋关节置换治疗晚期股骨头缺血性坏死的中期疗效观察

Mid-term Effect of Hybrid Total Hip Arthroplasty in the Treatment of Patients with Advanced Avascular Necrosis of Femoral Head

【目的】对使用混合型人工全髋关节置换治疗晚期股骨头缺血性坏死的患者进行术后中期的影像学及临床评估，探讨其疗效及其影响因素。【方法】由同一术者对35例晚期股骨头缺血坏死的患者行混合型人工全髋关节置换术，男17例，女18例，年龄28～73岁，左髋19例，右髋16例，按Ficat—Arlet分期，Ⅲ期20髋，Ⅳ期15髋。临床评估以Harris评分为标准。影像学评估根据术后随访时骨盆正位与髋关节正、侧位X线片。假体的生存率采用Kaplan-Meier分析，分别以髋臼、股骨假体的无茵性松动和任何原因所致的翻修为终点。【结果】30髋获得完整随访，随访时间5～9年，平均7．2年。术前Harris评分平均为23～62（45．0±9．4）分，终末随访时平均为75～100（90．4±6．3）分。Kaplan—Meier分析假体生存率为100％。术后照片假体形态及位置良好，截至末次随访时无一例翻修或表现为影像学无菌性松动。骨盆和股骨局灶性骨溶解各1例。5髋出现髋部轻度疼痛，2例出现静脉血栓形成，经保守治疗后3个月内均好转。【结论】混合型人工全髋关节置换是一种治疗晚期股骨头缺血性坏死的有效方法，其远期效果需进一步随访。

[Objective] To evaluate the mid-term clinical and radiographic outcomes of hybrid total hip arthroplasty （THA） for the treatment of patients with advanced avascular necrosis of femoral head. [Methods] From July 2000 to March 2004, 35 hybrid total hip arthroplasties were performed in 35 patients with osteonecrosis of the femoral head by one surgeon. This study involved 17 males and 18 females, and the age of the pa tients was from 28 to 73 years. AVN was classified according to the Ficat-Arlet classification as 20 stage III and 15 stage IV. The mid-term （equal to or more than 5 years） results of hybrid THA were examined. Clinical outcomes were evaluated according to Harris evaluation score. Kaplan -Meier analysis was performed to evaluate the survival of the femoral and acetabulum components. End point was radiographic loosening or revision of the acetabular component, and revision of the femoral component for any reason. [Results]Thirty hips in 35 patients were followed up for 7.2 years. The mean Harris hip score improved from preoperation （45.0±9.4） points to （90.4±6.3） points at the end of follow-up. Only one focal area of pelvic osteolysis in one patient and one small focal areas of femoral osteolysis in another patient were identified. When loosening was used as the end point for failure, the survival rate of the acetabular and femoral components was 100%. Five hips had slight pain and 2 cases had deep venous thrombosis, which resolved completely within 3 months. [Conclusion] Hybrid total hip arthroplasty in patients with advanced avascular necrosis of femoral head has a satisfactory clinical mid-term outcome, and the long-term outcome needs longer follow-up in the future studies.