应用矩形截面锥形股骨假体行人工全髋关节置换的中期疗效

MEDIUM-TERM EFFECTIVENESS OF TOTAL HIP ARTHROPLASTY WITH STRAIGHT TAPERED RECTANGULAR FEMORAL PROSTHESIS

目的探讨应用矩形截面锥形股骨假体行人工全髋关节置换术后的中期疗效。方法 2004年5月-2006年6月,对58例61髋髋关节疾患患者采用矩形截面锥形股骨假体行人工全髋关节置换,回顾分析获6年以上随访的43例45髋患者临床资料。男21例23髋,女22例22髋;年龄25～75岁,平均51.6岁。单髋置换41例,双髋置换2例。先天性髋关节发育不良12例12髋,髋臼发育不良伴骨性关节炎1例1髋,小儿麻痹症后遗髋关节畸形1例1髋,股骨颈骨折9例9髋,股骨头缺血性坏死8例8髋,髋关节骨性关节炎8例8髋,类风湿性关节炎2例3髋,强直性脊柱炎累及髋关节2例3髋。术前髋关节Harris评分为(41.7±10.4)分。术后行X线片检查,分析股骨假体位置,评价骨-假体界面稳定性;应用Harris评分标准评价髋关节功能。结果术中发生假体周围骨折3髋,术后大腿痛4髋。患者均获随访,随访时间74～99个月,平均85个月。末次随访时髋关节Harris评分为(87.6±8.3)分,与术前比较差异有统计学意义(t=23.14,P=0.00)。X线片检查示,术后发生异位骨化9髋,不同程度股骨近端应力遮挡性骨吸收42髋;骨-假体界面稳定,无感染、脱位及无菌性松动翻修发生,股骨假体生存率达100%。结论采用矩形截面锥形股骨假体行人工全髋关节置换中期疗效满意。

Objective To investigate the medium-term effectiveness of straight tapered rectangular femoral prosthesis in total hip arthroplasty （THA）. Methods Between May 2004 and June 2006, 58 cases （61 hips） of hip joint disease underwent THA with straight tapered rectangular femoral prosthesis and the clinical data of 43 cases （45 hips） followed up more than 6 years were retrospectively analyzed. There were 21 males （23 hips） and 22 females （22 hips） with an average age of 51.6 years （range, 25-75 years）, including 12 cases （12 hi ps） of congenital developmental dysplasia of the hi p, 1 case （1 hip） of osteoarthritis secondary to acetabular dysplasia, 1 case （1 hip） of hip deformity after poliomyelitis, 9 cases （9 hips） of femoral neck fractures, 8 cases （8 hips） of avascular necrosis of the femoral head, 8 cases （8 hips） of osteoarthritis of the hip joint, 2 cases （3 hips） of rheumatoid arthritis, and 2 cases （3 hips） of ankylosing spondylitis. Unilateral replacement was performed in 41 cases and bilateral replacement in 2 cases. The Harris score was 41.7 ± 10.4 before operation. X-ray examination was performed to analyze the location of femoral prostheses and evaluate the stability of the prosthesis-bone interface, and Harris score was used to evaluate the hip function. Results Periprosthetic fracture occurred in 3 hips, and thigh pain in 4 hips after operation. Forty-three cases （45 hips） were followed up 74-99 months （mean, 85 months）. Harris score was 87.6 ± 8.3 at last follow-up, showing significant difference when compared with preoperative score （t=-23,14, P=O.O0）. The X-ray examination showed that 9 hips had heterotopic ossification; bone resorption caused by stress shielding was observed at the proximal femur in 42 hips. But the stability of the prosthesis-bone interface was good; no infection or dislocation occurred; and no revision for aseptic loosening was performed in all cases. The survival rate of the femoral prosthesis was 100% during medium-term follow-up. Conclusion THA with straight tapered rectangular femoral prosthesis has good medium-term effectiveness.