股骨颈组配式假体在全髋关节置换术后偏心距重建中的作用

The role of modular femoral component in restoring femoral offset after total hip arthroplasty

目的探讨股骨颈组配式假体对全髋关节置换术后偏心距重建的意义。方法对2009年6月至2012年6月使用股骨颈组配式假体行全髋关节置换术的75例患者进行回顾性研究，男42例，女33例；年龄44-83岁，平均（64．7±12）岁。左髋40例，右髋35例。术前Harris髋关节功能评分32-65分，平均（54＋6）分。均采用M／LTaperwithKinectiv假体系统。术前应用模板技术预计假体大小及偏心距，术中实体测量，结合术前计划和术中情况选取大小合适的股骨颈假体，恢复偏心距，重建髋关节外展力臂。术后于x线片上测量偏心距及下肢长度。术后1、3、6、12个月及以后每年随访一次，采用Harris髋关节功能评分评价疗效。结果股骨偏心距均得到重建，误差从-3.0-3．0mm，平均（1．3±0．3）mm。双下肢长度差平均（3．0±0．8）mm。术后随访6-36个月，平均19．7个月。术后12周站立位髋关节外展角平均40°±10°；Harris髋关节功能评分65--94分，平均（86±13）分，与术前比较差异有统计学意义（t=19．360，P=0．000）。末次随访时Harris髋关节功能评分78固8分，平均（95±15）分。随访期间未出现关节脱位和髋臼股骨撞击征病例。结论使用股骨颈组配式假体可在不影响下肢长度的情况下恢复患肢的股骨偏心距，获得良好的髋关节外展肌力、活动度及稳定性，术后近期并发症发生率低。

Objective To assess the clinical significance of modular femoral component in restoring femoral offset after total hip arthroplasty. Methods Data of 75 patients, who had undergone THA with modular femoral component from June 2009 to June 2012, were retrospectively analyzed. There were 42 males and 33 females, aged from 44 to 83 years （average, 64.7：t=12 years）. There were 40 cases of left hip and 35 cases of fight hip. The average Harris hip score was 54＋6 （range, 32 to 65） before operation. The Zimmer MfL Taper hip prosthesis with Kinectiv technology was used in all patients. Preoperative templating was uti- lized to accurately predict the prosthetic size and the femoral offset. During the surgery, the femoral offset was measured accurate- ly, and the appropriate femoral neck prosthesis was selected in order to restore the femoral offset and reconstruct hip abductor moment arm. The femoral offset and leg length were measured according to X-rays after operation. The Harris hip score was used to assess the clinical results. Results The femoral offset was reconstructed in all patients, ranging from -3.0 to 3.0 mm （average, 1.3±0.3 mm）. The average leg length discrepancy was improved to 3.0±0.8 ram. All patients were followed up for 6 to 36 months （average, 19.7 months）. The average hip abduction angle was 40°＋10° at 12 weeks after operation. The average Harris hip score was 86±13 （range, 65-94） at 12 weeks after operation and 95±15 （range, 78 to 98） at final follow-up. There was no hip dislocation and femoral acetabular impingement syndrome. Conclusion Modular femoral component can restore femoral offset without changing the leg length, which can result in good hip abductor strength, range of motion of the hip and stability, as well as less complications.