Tri-lock骨保留型股骨新假体全髋关节置换术的早期疗效观察

Clinical apprehension on application of Tri-lock BPS total hip arthroplasty

目的：探讨Tri-lock骨保留型股骨新假体全髋关节置换术的早期疗效和临床体会。方法：2010年5月至2011年7月，采用Tri-lock骨保留型股骨新假体行全髋关节置换术治疗31例（32髋）髋关节疾患，男18例，女13例；年龄50～77岁，平均60.5岁。其中股骨头坏死8例，新鲜股骨颈骨折13例，先天性髋关节发育不良10例。按照手术前后患者髋关节功能（Harris 标准）、术后股骨柄假体的生物学固定情况（Engh标准）、术后股骨侧的骨长入情况（按Gruen分区描述）等，对Tri-lock骨保留型股骨新假体临床应用特点进行分析。结果：术后患者均Ⅰ期临床愈合，无早期并发症发生。31例（32髋）均获随访，时间10～14个月，平均12.2个月。Harris髋关节评分从术前的38.3±4.9提高到最后随访的92.5±11.2（t=27.53，P〈0.01）.术后X线片显示关节假体位置良好，肢体长度及股骨偏心距基本恢复正常，股骨柄假体的初始固定均符合优良标准，置换后随访3个月的X线片示Gruen Ⅱ区和Ⅵ区的近段Gription微孔涂层区均出现典型的骨锚固征。结论：Tri-lock骨保留型假体设计更符合人体解剖特征，髋关节功能恢复快，骨量保留多，为治疗髋部疾患提供了一种新的更好的选择。

Objective： To study short-term results and clinical application of Tri-lock BPS in total hip arthoplasty. Methods： From May 2010 to July 2011,32 hips in 31 patients（18 males and 13 females,ranging in age from 50 to 77 years old,with an average of 60.5 years old） were treated by total hip arthroplasty with Tri-lock BPS,including 8 patients with osteonecrosis（ON）,13 patients with fresh femoral neck fracture,10 patients with developmental dysplasia of the hip（DDH）. The therapeutic effects were evaluated by self assessment form,preoperative and postoperative Harris hip score,radiographs,Engh score and bone in growth of femoral side described by Gruen. Based on the short-term results,its design characteristic and clinical properties were analyzed. Results： All the incisions healed well and there were no complications such as femoral fracture,infection,dislocation and neurovascular injuries. All the patients were followed up with an average time of 12.2 months（ranged,10 to 14 months）. All the joints had good or excellent clinical results. The Harris score increased from preoperative 38.3±4.9 to 92.5±11.2 at the latest follow-up（t=27.53,P〈0.01）. Radiographically,the positions of the prostheses were normal,the average limbs length and femoral eccentricity recovered to normal. X-ray of the hips showed that the femoral stem prosthesis was in line with good initial fixed standard. At 3 months after surgery,X-ray of the hips showed that bone in growth in Gruen Ⅱ and Ⅵ of femoral side. Conclusion： Short-term results show that the design of Tri-lock BPS is more in line with human anatomy,and has the advantages in rapid recovery of hip function and retains more bone mass. It offers a newly valuable technology for the treatment of osteonecrosis,femoral neck fracture and DDH and so on.