骨小梁金属髋臼杯在脊髓灰质炎后遗症患者非瘫痪侧全髋关节置换术中的应用

Use of trabecular metal acetabular component in total hip arthroplasty performed on patients with residual poliomyelitis

目的了解脊髓灰质炎后遗症患者进行非瘫痪侧人工全髋关节置换术时使用钽杯的临床疗效及并发症发生率。方法选取上海长征医院关节外科2014年1月至2015年1月因＂髋关节骨关节炎＂需行人工全髋关节置换术的脊髓灰质炎后遗症患者共5例,5例患者髋关节病变均为非瘫痪侧髋关节。术前根据水平面测量髋臼假体位置,测量标准为髋臼假体与水平面呈40°~45°外展角,前倾角度采用骨盆前倾角10°,髋臼假体位置使用术前制定方案,股骨侧假体仍为前倾10°放置。髋臼侧均使用钽金属涂层假体（Zimmer,TM）。术后6周随访时记录患者手术侧髋关节活动范围,并分别在术后即刻拍摄双髋正位片,术后6周拍摄双髋正侧位片及站立位双下肢全长片。所有患者均在手术前、术后1周和术后6周时进行Harris髋关节功能评分（Harris评分）。患者随访时间为12~24个月。由于本研究中病例数较少仅为5例,故使用描述性方法比较本组病例各随访时间点数据的差异。结果本组病例所有患者至末次随访时均未出现感染、脱位等并发症,手术前、后及术后6个月随访时的Harris评分分别为（63.0±6.7）、（82.6±1.5）和（92.5±1.3）分,手术后Harris评分有改善。术后6周、3个月、半年的髋关节活动范围为屈髋：（75.3±9.5）°,（91.2±5.6）°,（92.6±6.9）°;后伸：（5.6±3.2）°,（10.5±2.6）°,（10.3±3.2）°;外展：（10.3±3.9）°,（15.5±2.4）°,（16.5±4.5）°;内收：（15.8±3.4）°,（25.3±2.7）°,（29.3±3.1）°。结论合并脊髓灰质炎后遗症的患者在进行非瘫痪侧人工全髋关节置换术时应进行详细术前计划,假体安放位置应进行个体化设计,钽金属涂层髋臼杯由于良好的初始稳定性和骨长入效果更适用于这类患者。

Objective To assess the short-term clinical outcomes of the patients with residual poliomyelitis who underwent cementless total hip arthroplasty（ THA） using trabecular metal（ TM）acetabular component on their nonparalytic limbs. Methods From January 2014 to January 2015,five patients with residual poliomyelitis（ five hips,nonparalytic contralateral limbs） underwent THA using TM acetabular component at the femoral prosthesis. The acetabular prosthesis position was determined preoperatively by the standard of 40°-45° for the inclination and 10° for the anteversion. Harris hip scores,complications,and range of motion（ ROM） of the joints were determined by chart review and confirmed by questionnaire and examination before the surgery,one week and six weeks after the surgery and during the follow-up; the radiographs of bilateral hips and full-length lower limbs were taken six weeks after the surgery,which were reviewed by two observers. Follow-up was available for all the five patients at a minimum duration of one year. A descriptive method was used to compare the difference of each time point. Results All the patients had pain relief and improvement in the hip function; the mean Harris hip score improved from（ 63. 0 ± 6. 7） preoperatively to（ 82. 6 ± 1. 5） postoperatively,and（ 92. 5 ±1. 3） at the last follow-up（ P〈0. 05）. No complication occured. There was no loosening or osteolysis in this series. The average ranges of hip motions were as follows： six weeks after surgery,flexion（ 75. 3 ±9. 5） °,extension（ 5. 6 ± 3. 2） °,abduction（ 10. 3 ± 3. 9） °,adduction（ 15. 8 ± 3. 4） °; three months later,flexion（ 91. 2 ± 5. 6） °,extension（ 10. 5 ± 2. 6） °,abduction（ 15. 5 ± 2. 4） °,adduction（ 25. 3 ±2. 7） °; at the last follow-up,flexion（ 92. 6 ± 6. 9） °,extension（ 10. 3 ± 3. 2） °,abduction（ 16. 5 ±4. 5） °,adduction（ 29. 3 ± 3. 1） °. Conclusions Cementless THA may be suitable for painful hips in adult patients with residual poliomyelitis. Nonetheless,these patients should be informed of the possibility of dislocation and mild residual pain,particularly the patients whose THA are performed on the limb that is not affected by polio. TM is more suitable for these patients for it has better bone ingrowth performance.