解剖型股骨柄假体植入并发股骨近段骨折与股骨近段髓腔解剖分析

Relationship between the anatomic form of proximal femoral medullary cavity and the proximal femoral fracture caused by the implantation of anatomic femoral stem

目的分析Ribbed解剖型股骨柄假体植入并发股骨近段骨折的原因,探讨股骨髓腔解剖因素在股骨近段骨折中的重要影响。方法 2004年1月至2009年1月,我们采用德国Link公司解剖型股骨柄假体Ribbed柄对213例(254髋)行全髋关节置换术。对213例患者的髓腔形态归纳分析,随访时间最短的1年,最长的5年,平均3.6年,髋关节功能采用Harris评分。结果 82.63%(176/213)患者的髓腔形态为正常型,香槟型占9.39%(20/213),只有7.98%(17/213)的患者髓腔为烟囱型。术中有11例发生股骨近段的骨折(包括股骨颈骨折5例,大转子骨折6例),占了手术并发症的26.19%(11/42),占本组病例的5.16%(11/213)。骨折主要发生在香槟型患者中,占63.64%(7/11)。213例患者全部得到随访,11例股骨近段骨折患者术后无1例发生假体无菌性松动,95.31%(203/213)患者术后仍能从事原工作岗位,91.55%(195/213)的患者可以下蹲和穿鞋袜。按照Harris评分标准,术前平均为40.8分,术后平均为93.0分,优良率达到94.84%(202/213)。结论解剖型股骨柄假体植入时发生股骨近段骨折或植入困难和股骨髓腔的解剖形态有关系,选择解剖型假体时,应该考虑股骨近段的解剖形态。

Objective To investigate the relationship between the anatomic form of proximal femoral medullary cavity and the proximal femoral fracture caused by the implantation of Ribbed anatomic femoral stem.Methods Between Jan.2004 and Jan.2009,we performed total hip arthroplasty on two-hundred-and-thirteen patients（two-hundred-and-fifty-four hips） using the Link Ribbed femoral stems.Before the surgeries,the anatomic form of proximal femoral medullary cavity of each patient was analyzed and classified.After the surgeries,we followed-up all patients for 1-5 years（average=3.6 years）,and evaluated their hip joint function by Harris scoring.Results One-hundred-and-seventy-six patients（82.63%） had a normal proximal femoral medullary cavity;twenty patients（9.39%） had a champagne-flute type proximal femoral medullary cavity;only seventeen patients（7.98%） had a stovepipe type proximal femoral medullary cavity.Proximal femoral fracture occurred in eleven patients（including five patients with femoral neck fracture and six patients with greater trochanter fracture）,accounting for 5.16% of all patients and 26.19% of all complications.Seven of the eleven patients with proximal femoral fracture had a champagne-flute type proximal femoral medullary cavity（63.64%）.No aseptic loosening of Ribbed femoral stem was found.Two-hundred-and-three patients（95.31%） could engage in the former jobs,and one-hundred-and-ninety-five patients could squat down and wear shoes and socks.The average Harris score of the patients after the surgeries was significantly higher than that before the surgeries（93.0 vs 40.8）.Conclusion The anatomic form of proximal femoral medullary cavity is related to the proximal femoral fracture caused by the implantation of anatomic Ribbed femoral stem,and can contribute to the difficulty of the implantation.Therefore,the anatomic form of proximal femoral medullary cavity should be taken into account when selecting the anatomic implant.