全髋置换术中髋臼内陷的处理

Effectiveness of Total Hip Arthroplasty in Treating Protrusio Acetabuli

目的：探讨人工全髋关节置换术中髋臼内陷的处理方法及早期疗效。方法2006年7月至2012年12月，收治继发性髋臼内陷症21例28髋，男12例17髋，女9例11髋；年龄26-68岁，平均56.3岁；原发疾病：类风湿关节炎9例14髋，强直性脊柱炎6例8髋，感染4例4髋（结核和化脓性关节炎各2例2髋），髋臼骨折畸形愈合2例2髋；轻度髋臼内陷6髋、中度髋臼内陷12髋、重度髋臼内陷10髋。患者均行人工全髋关节置换，术中单纯植入生物型臼杯6髋，打压植骨后直接植入生物型臼杯18髋，直接植入骨水泥杯2髋，打压植骨后骨水泥杯固定2髋。结果术后21例28髋切口均一期愈合，无感染及下肢深静脉血栓形成等并发症发生。患者均获随访，随访时间12-78个月，平均42个月。末次随访时，髋关节 Harris 评分为（87±4.1）分，术前 Harris 髋关节评分平均（45±3.3）分，较术前有显著差异，优22髋，良6髋，优良率100%。臼杯平均外翻角（42±3.5）°。植骨均骨性融合，无臼杯再次内陷及松动。髋关节活动度增加：屈曲增加（64.3±4.5）°，外展增加（20.5±3.5）°，内旋增加（16.5±2.5）°，外旋增加（19±2.5）°。末次随访时 X 线片显示所有假体均获得骨性稳定。术前股骨头内陷3-30 mm，平均13 mm；术后股骨头内陷0-5 mm，平均2 mm。人工股骨头旋转中心外移3-28 mm，平均10.5 mm。假体位置良好，无松动、下沉，植骨与髋臼融合，无髋臼再次内陷。结论人工全髋关节置换治疗髋臼内陷时，恢复患髋股骨偏心距及髋臼旋转中心，可获满意早期疗效。

Objective To evaluate the result of total hip arthroplasty in the treatment of protrusio acetabuli. Methods From 2006. 7 to 2012. 12,21 cases（28 hips）of protrusio acetabuli were treated,including 12 males and 9 females with an av-erage age of 56. 3years（range,26 - 68years）. The preoperative Harris score was 45 ± 3. 3,there were 6 cases of mild,12 mod-erate cases,and 10 severe cases. All patients received total hip arthroplasty with recovery of femoral off set and acetabular cen-ter of rotation. Results All incisions healed without complication of infection,deep venous thrombosis,or nerve injury. All pa-tients were followed up 12 - 78 months with an average of 42 months. The Harris score at last follow-up was 87 ± 4. 1,showing significant difference when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsid-ence was observed,and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli,total hip arthroplasty with recovery the femoral off set and acetabular center of rotation and provide satisfactory early result.