保留股骨颈短柄假体在治疗晚期股骨头坏死中的应用

Application of CFP short-stem prosthesis in the treatment of osteonecrosis of the femoral head

目的观察保留股骨颈短柄股骨假体全髋关节置换术（THA）治疗晚期股骨头坏死的短期疗效。方法2008年6月至2009年12月，采用保留股骨颈短柄股骨假体全髋关节置换术治疗晚期股骨头坏死8例（9髋），平均年龄24．1（20～36）岁。酒精性者3例（3髋），激素性者5例（6髋）。按照世界骨循环研究学会（ARCO）分期，Ⅲ-C期7髋，Ⅳ期2髋。通过Harris评分及x线片评价临床效果。结果平均随访18．1（12～30）个月，术前Harris评分平均为（42．8±8．6）（21～52）分，终末随访时平均（92．8±6．1）（80～100）分，优7髋，良2髋。X线片上髋臼和股骨无骨吸收或骨溶解，假体无松动征象。疼痛解除，无并发症发生。结论使用保留股骨颈短柄股骨假体全髋关节置换术治疗年轻患者晚期股骨头坏死的短期效果满意。

Objective To investigate the clinical outcome for the treatment of osteonecrosis of the femoral head （ONFH） in advanced stage by a short-stem prosthesis preserving femoral neck in total hip arthroplasty （THA）. Methods From June 2008 to December 2009, 9 hips in 8 patients with advanced stage of ONFH were treated by a short-stem preserving femoral neck in THA. The mean age was 24. 1 years （range：20 -36）. There were 3 patients （3 hips） with alcohol-induced ONFH and 5 patients （6 hips） with steroid-induced ONFH. According to the classification of Association Research Circulation Osseous （ARCO）, 7 hips were in stage Ⅲ-C and 2 hips in stage IV respectively. The clinical outcomes were evaluated according to the Harris evaluation score and radiographic analysis. Results All patients were followed up for a mean duration of 18. 1 months （range：12 -30）. The mean Harris hip score improved from preoperative （42. 8 ±8. 6） points to（92. 8 ±6. 1 ）points at the time of final follow-up. The outcomes were excellent in 7 hips and better in 2 hips. Neither osteolysis of mortar and femur nor loose component was found from radiological films. The pain of all hips disappeared and no complications occurred. Conclusion The short-term clinical outcome is satisfactory for treating young patients with advanced stage of ONFH by a short- stem prosthesis preserving femoral neck in THA.