生物型人工全髋关节置换术联合打压植骨治疗类风湿性关节炎伴髋臼内陷

CEMENTLESS TOTAL HIP ARTHROPLASTY AND IMPACTED BONE GRAFTING FOR PROTRUSIO ACETABULI IN PATIENTS WITH RHEUMATOID ARTHRITIS

目的探讨使用生物型假体行人工全髋关节置换术联合打压植骨重建髋臼治疗类风湿性关节炎伴髋臼内陷的疗效。方法 2001年1月-2009年4月,收治类风湿性关节炎伴髋臼内陷患者18例（20髋）。男6例,女12例;年龄36-62岁,平均46岁。病程3-10年,平均6年。术前Harris评分为（40.25±6.68）分。髋臼内陷（5.70±4.26）mm;根据Sotelo-Garza和Charnley分型：1型（内陷1-5 mm）12髋,2型（内陷6-15 mm）5髋,3型（内陷〉15 mm）3髋。采用生物型关节假体行人工全髋关节置换术,自体骨打压植骨重建髋臼。结果手术时间48-126 min,平均74 min;失血量150-650 mL,平均350 mL。术后2例切口愈合不良,3例出现下肢深静脉血栓形成;其余患者切口均Ⅰ期愈合,无并发症发生。患者均获随访,随访时间60-156个月,平均108个月。X线片复查示,术后6个月内自体移植骨均与髋臼融合。末次随访时髋臼内陷（—1.11±0.45）mm,与术前比较差异有统计学意义（t=5.66,P=0.00）。末次随访时,Harris评分为（87.20±4.21）分,与术前比较差异有统计学意义（t=—27.68,P=0.00）。随访期间均无髋臼假体松动发生。结论对于类风湿性关节炎伴髋臼内陷,选择生物型关节假体行人工全髋关节置换术,同时联合自体骨打压植骨重建髋臼治疗可获得较满意中期疗效。

Objective To evaluate the effectiveness of total hip arthroplasty（THA） with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis（RA） with protrusio acetabuli. Methods Between January 2001 and April 2009, 18 cases（20 hips） of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years（range, 36-62 years）. The disease duration was 3-10 years（mean, 6 years）. Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was（5.70±4.26） mm. According to SoteloGarza and Charnley classification criterion, there were 12 hips of type 1（protrusio acetabuli 1-5 mm）, 5 hips of type 2（6-15 mm）, and 3 hips of type 3（〉15 mm）. All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. Results The average operation time was 74 minutes（range, 48-126 minutes）; the average blood loss was 350 m L（range, 150-650 m L）. Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months（range, 60-156 months）. According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score（t=—27.68, P=0.00）; the protrusio acetabuli was（—1.11±0.45） mm, showing significant difference when compared with preoperative value（t=5.66, P=0.00）. No loosening of acetabular components was found. Conclusion For RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.