髋臼内陷症的全髋关节置换术

The total hip arthroplasty for protrusio acetabuli

目的 探讨全髋关节置换术治疗髋臼内陷症的手术操作方法和临床疗效.方法 2003年6月至2008年5月,采用全髋关节置换术治疗髋臼内陷症31例35髋,男16例18髋,女15例17髋;年龄36～71岁,平均52.2岁.手术均采用后外侧入路,股骨头取出困难时采用逆行取出法,分别处理髋臼环和髋臼底,取自体松质颗粒骨修复骨缺损,采用压配方式植入非骨水泥型全髋关节假体.术后1、3、6、12个月门诊随访,以后每年随访1次,随访时采用Harris髋关节评分评估髋关节功能,摄X线片观察假体是否有松动和再次内陷,植骨是否愈合.结果 全部病例随访19～152个月,平均46.5个月.1例患者术后第2天出现右下肢深静脉血栓,经抗凝处理后痊愈;1例术后2个月出现轻度大腿痛,无特殊处理,术后6个月消失,无其他并发症发生.术前Harris髋关节评分平均（48.9±6.5）分,末次随访增至平均（91.2±5.7）分,较术前平均改善42.3分.X线片显示所有假体均获得骨性稳定,无松动和再次内陷,术后平均6个月植骨愈合.结论 对于内陷髋臼,采用不同于普通全髋关节置换的手术技术,外移髋臼至旋转中心,用植骨修复骨缺损,选择非骨水泥型假体重建髋臼,可获得较好的临床效果,髋臼松动和再次内陷发生率低.

Objective To evaluate the clinical outcome of total hip arthroplasty （THA） for protrusio acetabuli. Methods Between 2003 to 2008, 31 patients（35 hips） with protrusio acetabuli were treated with THA, including 16 males （18 hips） and 15 females （17 hips）. The age ranged from 36 to 71 years （average age 52.2 years）. The femoral heads were moved out with retrograde method when necessary via posterior-lateral hip incision. The acetabular loops and bottoms were prepared respectively. Auto-bone grafting was used to repair acetabular defects and cementless prostheses were planted with press-fit skills. At follow-up visit,the hip functions were evaluated by Harris score. The loosening, re-protrusion and the union of graft bone was judged by X-ray. Results The mean follow-up was 46.5 months （19-152 months）. One patient developed DVT on the second day post-operatively who recovered well after anticoagulation treatment. One patient complained of gentle thigh pain which disappeared at 6 months. No other complication was found. The mean Harris scores had improved from 48.9±6.5 pre-operatively to 91.2±5.7 post-operatively. All prostheses acquired bone stabilization with no sign of loosening and re-protrusion and the grafts bone were healed at a mean 6 months according to X-ray. Conclusion THA with acetabular bone grafting and cementless component for protrusio acetabuli have acquired excellent results and prevented loosening and re-protrusio effectively.