股骨近端粗隆间后侧纵形截骨法在全髋关节翻修术中的应用

Posterior longitudinal strip osteotomy of proximal femor in revision total hip arthroplasty

目的 探讨股骨近端粗隆间后侧纵形截骨在全髋翻修术中应用的初步经验.方法 2005年9月至2009年12月对35例患者应用股骨近端粗隆间后侧纵形截骨法取出股骨侧假体,截骨长度约11～14 cm,宽约1 cm.翻修假体为生物固定型组合式翻修假体,腔隙性骨缺损采用了颗粒异体骨植骨,钢丝环扎固定复位截骨块.对手术前、后Harris评分、肢体长度以及影像学改变进行评估.术前Harris评分平均30分（19～40分）,其中疼痛评分平均12分（10～20分）.结果 35例患者术后平均随访15个月（5～55个月）.术后Harris评分平均85分（80～92分）,其中疼痛评分平均40分（30～44分）.股骨截骨处及植骨均愈合,平均愈合时间约20周（10～32周）.未发生钢丝滑脱、感染、脱位、假体松动等并发症.结论 短期随访表明,股骨近端粗隆间后侧纵形截骨法有利于股骨假体的显露和取出,便于髓腔清理以及股骨侧重建,在全髋翻修术中是一种操作相对容易、有效町靠的方法.

Objective To evaluate the treatment and effect of a technique using single femoral posterior longitudinal strip osteotomy in revision total hip arthroplasties. Methods Between September 2005 and December 2009, 35 hips of 35 patients underwent a revision total hip arthroplasties （ THA） in conjunction with extraction of femoral components. Among them, 23 cases were with uncemented, and 12 cases were with cemented femoral components. Those cases being followed up were chosen by two standards described as follows： one was the examination of preoperative radiographs, which showed that there was difficult in the extraction of the femoral components; Another followed was the trying with routinal procedure to remove the stem. If these were unsuccessful, a single longitudinal strip osteotomy was performed, whose length was about 11-14 cm, and width was about 1 cm. Then the femoral component was disimpacted. The osteotomy was fixed with wires or cables. If there was cortical deficiency or insufficient cancellous bone, grafting was performed. A cementless composite revision prosthesis of the Lima-Lto with a tapered modular distal fixation stem was used. All the patients were evaluated with preoperative and postoperative Harris score, the length of limb and radiographs. Results All cases were followed up with 5 to 55 months, average 15 months. Compared with preoperative, the average Harris score increased from 30 （range, 19-40 points） to 85 points （range, 80-92 points）. All pains of hip joint were alleviated from the mean 12 points （range, 10-20 points） before the operation to 40 points （range, 30-44 points） after the operation. All the femoral osteotomy and bone grafting were healing ultimately. And on average, the healing began in 20 weeks （range, 10-32 weeks）. All the cases remain the same length of lower limbs. There was no hip joint dislocation, loosening or infection. Conclusions The femoral posterior longitudinal strip osteotomy faciliates the exposure and extraction of the femoral stem, the clear up of medullary cavity and then the femoral reconstruction in revision total hip arthroplasties. It has satisfactory short-term radiographic evaluation and clinical effect as a simple, effective and reliable technique.