成人期股骨头骨骺滑脱症的全髋关节置换

Total hip arthroplasty for treatment of adult patients with slipped capital femoral epiphysis

[目的]探讨全髋关节置换术治疗成人期股骨头滑脱继发股骨头颈短缩畸形的临床疗效。[方法]2009年9月~2014年1月应用全髋关节置换术治疗成人期股骨头滑脱患者28例(30髋),男21例,女7例;年龄27岁~66岁,平均(48.6±9.3)岁。通过真臼重建、梯度软组织松解和撬拨复位良好地实现了髋关节置换。术后对患者满意度、髋关节功能恢复和双下肢长度恢复等情况进行评估。[结果]所有患者均获得随访,随访时间15~72个月,平均(38.5±3.7)个月。Harris髋关节评分由术前(48.1±4.5)分(41~62分)提高至末次随访时的(93.1±3.8)分(88~96分),术前及术后髋关节功能的差异有统计学意义(t=27.31,P<0.001)。其中优18例(20髋)、良10例(10髋),优良率100%。28例髋术后均立即实现了髋臼及股骨柄的生物性压配与初始稳定,术后3个月X线片上均获骨性固定。2例术后有腓总神经牵拉损伤症状,未行特殊处理,应用神经营养药物及保持下肢膝关节屈膝位,2~3周后下肢麻木消失,术后4周左右下肢肌力均完全恢复正常。随访期间无髋关节脱位、假体感染及松动发生。[结论]全髋关节置换术治疗成人期股骨头滑脱合并股骨头颈短缩可获得令人满意的手术效果,采用梯次松解法可对髋周软组织挛缩进行有效松解。

[Objective] To investigate the clinical outcome of total hip arthroplasty（THA） in the treatment of femoral head and neck shortening secondary to slipped capital femoral epiphysis（SCFE） in adult patients. [Methods] A total of 28 adult patients（30 hips） who underwent THA for the treatment of femoral head disease from September 2009 to January 2014 were enrolled, including 21 male and 7 female patients aged 27-66 years（mean 48.6±9.3 years）. THA was well performed with reconstruction of true acetabulum, soft tissue release, and poking reduction. The patients＇ degree of satisfaction, recovery of hip joint function, and recovery of leg length were evaluated. [Results] All the patients were followed up successfully, and the mean follow-up time was 38.5±3.7 months（range 15-72 months）. The Harris hip score was significantly improved from 48.1±4.5（41-62） before surgery to 93.1±3.8（88-96） at the final follow-up（t=27.31, P=0.00）. Among all the patients, 18（20 hips）achieved excellent response and 10（10 hips） achieved good response, resulting in an excellent and good results rate of100%. After surgery, all the patients immediately achieved the biological press fit and initial stability of the acetabulum and femoral stem, and at 3 months after surgery, the X-ray film showed bony fixation. Two patients experienced traction injury in the common peroneal nerve after surgery, the neurotrophic drugs were used and the patients were asked to bend their knees,lower limb numbness disappeared 2-3 weeks later. At about 4 weeks after surgery, muscle strength of the lower limbs returned to normal. There were no dislocation of hip joint, prosthesis-related infections, or prosthetic loosening during follow-up. [Conclusions] THA can achieve satisfactory surgical outcome in adult patients with SCFE and femoral head and neck shortening,and soft tissue release can effectively deal with soft tissue contracture around the hip.