短柄股骨假体在年轻类风湿性关节炎患者关节置换术中的应用

Total Hip Arthroplasty with Short Stem in Youth Patients with Rheumatoid Arthritis

目的探讨短柄股骨假体在类风湿性关节炎年轻患者人工关节置换术中的应用及近期临床疗效。方法2012年3月至2013年5月,对15例（20髋）年轻类风湿性关节炎患者Dorr C型股骨髓腔采用短柄生物型股骨假体行人工髋关节置换。其中男10例（14髋）,女5例（6髋）;年龄22~35岁,平均26.5岁。所有病例均合并不同程度的骨质疏松,按Singh指数分级,Ⅱ级6例,Ⅲ级14例。术后行X线片检查评估假体柄位置,Engh标准评价骨-假体界面稳定性,Harris评分标准评价髋关节功能。结果全部病例获得随访,获16~41个月（平均27个月）随访。15例（20髋）Harris髋关节评分由术前（62.1±8.7）分提高至末次随访时（94.5±3.6）分,差异有统计学意义（t=9.8,P=0.000）。术后即刻X线片均显示股骨短柄假体与髓腔紧密压配。末次随访时20髋均有明显股骨骨皮质增厚;15髋有不同程度股骨近端应力遮挡性骨吸收,其中Ⅰ度（股骨矩密度低,且变圆钝）12髋,Ⅱ度（累及小转子）3髋。本组病例无大腿痛发生。结论年轻类风湿患者使用生物型短柄的股骨假体可以得到良好的匹配并有效保留良好的股骨近端骨量,表面钛微孔涂层可有效促进骨长入,短小的柄端在髓腔内的指向作用可有效避免髋内外翻的发生。

Objective To investigate the short-time clinical efficacy of total hip arthroplasty with short stem in youth patients with rheumatoid arthritis. Methods From March 2012 to May 2013,15 patients （20 hips） underwent total hip arthroplasty with short stem in youth patients with rheumatoid arthritis with Dorr C femoral canal in our hospital. There were 10 males （ 14 hips） and5 females （6 hips）, aged from 22 to 35 years （average ,26.5 years）. All patients had a certain degree of osteo- porosis. According to Singh index classification：Singh type Ⅱ of 6 hips, Singh type Ⅲ of 14 hips. The postoperatively X-ray ex- amination was performed to analyze the location of femoral prostheses and evaluate the stability of the prosthesis-bone inter- face. Harris score was used to evaluate the hip function. Results All patients were followed up for an average of 27 months （range,16 to 41 months）. The Harris hip score was improved from preoperative （62.1 ± 8.7） to （94.5 ± 3.6） at finial fol- low-up,there were significant difference before and after operation（ t = 9.8 ,P = 0. 000） in Harris score. The initial postopera- tive X-ray showed good canal filling in all chimney-type femoral canals. All patients had obvious thickening of femoral bone cortex in finial follow-up. 15 hips had different degree of femoral proximal stress shelter bone absorption,type one （The femur had bone loss） of 12 hips,type two （The lesser trochanter had bone loss） of 3 hips. This group of cases without thigh pain occurred. Conclusion With short stern has a good stem-canal fitting and bone-conserving in youth patients with rheumatoid arthritis. Proximally porous-coated tapered designs with a reduced distal end of the stem can provide physiologic loading to the proximal part of the femur.