人工全髋关节置换术治疗陈旧性髋关节中心性脱位

ACETABULUM RECONSTRUCTION AND TOTAL HIP ARTHROPLASTY FOR TREATMENT OF OLD CENTRAL DISLOCATION OF HIP JOINT

目的探讨应用人工全髋关节置换术（total hip arthroscopy,THA）治疗陈旧性髋关节中心性脱位的临床疗效。方法 2010年1月-2014年6月,收治陈旧性髋关节中心性脱位患者21例（21髋）,均行THA治疗,术中自体骨植骨重建髋臼。男13例,女8例;年龄60~75岁,平均67.4岁。左髋12例,右髋9例。致伤原因：高处坠落伤6例,交通事故伤9例,压砸伤4例,其他原因2例。伤后至该次手术时间1~20年,平均9.6年。患者主要临床症状为髋关节关节疼痛、活动受限及跛行等创伤性关节炎表现。Harris评分为（32.95±2.06）分,疼痛视觉模拟评分（VAS）为（8.14±0.73）分。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间1.9~6.4年,平均4.6年。X线片复查示,植骨均融合,融合时间4~24个月,平均12.5个月;植骨无明显吸收,无骨溶解、感染等并发症发生。随访期间假体无松动、下沉,假体周围无透亮区。术后1周及1年髋关节Harris评分分别为（87.67±2.01）、（92.10±1.95）分,VAS评分分别为（2.57±0.81）、（0.19±0.51）分,均较术前显著改善,比较差异有统计学意义（P〈0.05）。结论对于陈旧性髋关节中心性脱位,通过THA可恢复髋关节正常旋转中心,重建髋关节功能。

Objective To explore the clinical effect of total hip arthroplasty（THA） in the treatment of old central dislocation of the hip joint. Methods Between January 2010 and June 2014, 21 patients（21 hips） with old central dislocation of the hip joint underwent THA and autologous bone graft for acetabulum reconstruction. There were 13 males and 8 females, aged 60-75 years（mean, 67.4 years）. The left hip was involved in 12 cases and the right hip in 9 cases, with a disease course of 1-20 years（mean, 9.6 years）. The causes were falling from height in 6 cases, traffic accident in 9 cases, crushing in 4 cases, and others in 2 cases. Hip pain, limited activity, and lameness were the main clinical symptoms. Preoperative Harris score was 32.95±2.06 and visual analogue scale（VAS） was 8.14±0.73. Results Primary healing of incision was obtained in all patients. The patients were followed up 1.9-6.4 years（mean, 4.6 years）. The X-ray films showed bone graft fusion at 4-24 months（mean, 12.5 months）; there were no complications of grafted bone absorption, osteolysis, and infection. During follow-up, no prosthetic loosening or sinking, and no translucent zones around the prosthesis were observed. Harris score was significantly improved to 87.67±2.01 at 1 week and 92.10±1.95 at 1 year; and VAS score was significantly decreased to 2.57± 0.81 at 1 week and 0.19 ± 0.51 at 1 year（P0.05）. Conclusion THA is an effective surgical treatment for old central dislocation of the hip joint, because it can restore normal hip rotation center and reconstruct the hip joint function.