保留股骨颈型人工全髋关节置换术治疗中青年髋关节疾病

ARTIFICIAL TOTAL HIP ARTHROPLASTY WITH COLLUM FEMORIS PRESERVING FOR TREATING HIP JOINT DISEASE IN YOUNG AND MIDDLE-AGED PATIENTS

目的探讨保留股骨颈型人工全髋关节置换术(totalhip arthroplasty,THA)治疗中青年髋关节疾病的临床疗效。方法2002年3月-2005年3月,采用保留股骨颈型THA治疗26例31髋中青年髋关节疾病患者。男19例23髋,女7例8髋;年龄32～48岁,平均37岁。左侧17髋,右侧14髋。缺血性股骨头坏死致髋关节骨性关节炎9例,缺血性股骨头坏死7例,髋臼发育不良致股骨头坏死3例,强直性脊柱炎致髋关节骨性关节炎1例,类风湿性关节炎2例;病程2～11年,平均5.6年。股骨颈头下型骨折2例于伤后5d手术;股骨颈头下型骨折不愈合2例,病程分别为24和26个月。主要临床症状为患髋疼痛,行走困难,跛行。X线片均排除骨质疏松。结果1例双侧患者术中截除股骨颈过多,致右侧假体柄远端股骨出现裂纹骨折,夹板固定后骨折愈合。患者术后切口均Ⅰ期愈合,无并发症发生。26例术后均获随访,随访时间4～7年,平均5.6年。1例术后因未正规功能锻炼,髋关节屈曲活动受限;其余患髋关节功能均改善,行走步态正常。1例术后诉髋关节持续隐痛,对症处理后6个月疼痛缓解。X线片示假体位置良好,末次随访时股骨距处无骨吸收发生;髋关节功能根据Harris评分标准评分为(91.31±0.77)分,与术前(50.88±0.90)分比较,差异有统计学意义(P<0.05);获优11髋,良18髋,中2髋,优良率为93.5%。结论应用保留股骨颈型THA治疗中青年髋关节疾病,保留了更多宿主骨质,利于再次假体翻修,临床疗效良好。

Objective To evaluate the therapeutic outcome of artificial total hip arthroplasty （THA） with collum femoris preserving for hip joint desease in young and middle-aged patients. Methods From March 2002 to March 2005,26 cases （31 hips） of hip joint disease were treated with artificial THA with collum femoris preserving,including 19 males （23 hips） and 7 females （8 hips） and aged 32-48 years with an average of 37 years. In 31 hips,17 left hips and 14 right hips were involved. There were 9 cases of osteoarthritis of the hip joint caused by avascular necrosis of the femoral head （ANFH）,7 cases of ANFH,3 cases of femoral head necrosis caused by dysplasia of acetabular,1 case of osteoarthritis of the hip joint caused by ankylosing spondylitis,and 2 cases of rheumatoid arthritis; the course of disease was 2-11 years （5.6 years on average）. Two cases of femoral neck fracture （Garden IV）,and 2 cases of non-union femoral neck fractures （1 for Garden III and 1 for Garden IV）,the course of disease was 5 days,24 months,and 26 months. The prime symptoms were pain,diffi cult walk and limp. All patients were taken X-ray to exclude osteoporosis. Results The right distal femur prosthesis of a bilateral patient cracked owing to excessive amputation of collum femoris,and fracture healed after symptomatic treatment. All the incisions healed by first intention and no complications occurred. All patients were followed up for 4-7 years,with an average of 5.6 years. One case had poor hip function because he did not follow rehabilitation procedure,and the others achieved good outcome with normal gait. One case complained of persistent pain 6 months after operation,and was relieved by administration of some non-steroidal anti-inflammatory drugs and anti-osteoporosis drugs 6 months later. The X-ray films after operation and at last follow up showed good location of prosthesis and no bone resorption. Harris score at last follow-up was 91.31 ± 0.77,and it was significantly higher than that before operation （50.88 ± 0.90）,（P 0.05）. The excellent and good rate was 93.5% （excellent in 11 hips,good in 18 hips,and fair in 2 hips）. Conclusion Artificial THA with collum femoris preserving can retain more bone,be easier for revision,and has an excellent outcome.