生物型全髋关节置换术治疗伴有股骨头颈短缩的髋臼内陷症

Total hip arthroplasty for acetabular protrusion combined with shortening of femoral head and neck

目的探讨生物型全髋关节置换术（THA）治疗位有股骨头颈短缩的髋臼内陷症的手术技巧和疗效。方法回顾性分析2008年8月至2012年3月采用THA治疗的15例（17髋）位有股骨头颈短缩畸形的髋臼内陷症患者资料，男6例6髋，女9例11髋；年龄21～68岁，平均45.6岁。髋臼肉陷症按Dunlop诊断标准分度：轻度1髋，中度11髋，重度5髋。股骨头颈短缩程度：轻度短缩5髋，中度短缩8髋，重度短缩4髋。术后随访行X线片检查观察假体与骨界面愈合的情况，采用髋关节Harris评分标准评定患髋功能。结果15例患者术后获10～46个月（平约28.5个月）随访。15例患者17髋术后均立即实现了髋臼及股骨柄的生物性压配。术后3个月X线片显示均获广泛性骨长入，达骨性固定。末次随访时无假体松动和髋臼再次内陷。术后6个月髋关节Harris评分由术前平均（43.1±4.8）分改善至（91.2±5.2）分，末次随访仍维持在（92.5±3.1）分，术后6个月、末次随访时分别与术前比较差异均有统计学意义（P〈0.05）。结论生物型THA治疗伴有股骨头颈缩短的髋臼内陷症疗效良好，术中操作要点是选择短头试模进于髋关节复位，在保持髋关节张力情况下对髋关节囊及周围软组织孪缩由里向外依次分层松解。

Objective To evaluate the operative techniques and clinical outcaomes of total hiparthroplasty （THA） for acetabular protrusion combined with shortening of femoral head and neck. Methods From August 2008 to March 2012, 15 patients （17 hips ） with acetabular protrusion combined with shortening of femoral head and neck were treated with THA. They were 6 males （6 hips ）and 9 females （11 hips）,aged from 21 to 68 years （average, 45.6 years ）. According to Dunlop＇s criteria, the acetabular protrusion was mild in one hip , moderate in 11 hips and severe in 5 hips , Mild shortening was present in 5 hips, moderate shortening in 8 hips and sever shortening in 4 hips. The acetabular walls were rasped respectively. Auto-bone grafting was impacted on the acetabular bottom to recover the acetabular center of rotation and cementless prostheses wrer planted with press-fit skills. The hip capsule and surrounding soft tissues were released after reduction of the hip. At regular follow-ups, hip functions were evaluated by Harris scores and roentgenographic assessment of bone healing at the prosthesis-bone interface was performed according to Engh＇s description. Results The mean follow-up was 28.5 months （range, from 10 to 46 months）. Biologic press-fit of the acetabulum and femoral component was achieved in all hips immediately after operation. Massive bone ingrowth was acquired for bony stabilization at 3 months postoperatively on X-ray. No prosthetic loosening or re-protrusion was observed at the last follow-up. The mean Harris score improved from preoperative 43.1±4.8 points to 91.2±5.2 points at the 6-month follow-up, and remained 92.5±3.1points at the last follow-up. There were asgnificant differences between preoperation and 6 months post-operation and the last follow-up respectively （P〈0.05）. Conclusions Acetabular protrusion combined with shortening of femoral head and neck can be effectively treated by THA. The key operative ecthniques are hip reduction with a short head and neck model, and gradual releasing of the contracture of hip capsule and surrounding softtissues while a sufficient tension is maintained at the hip joint.