股骨头重度坏死患者髋关节置换术中软组织松解及髋臼重建术的应用

Application of soft tissue loosening and acetabular reconstruction in hip replacement for patients with severe femoral head necrosis

目的:探讨重度股骨头坏死患者全髋关节置换术中软组织松解及髋臼重建术的应用对改善关节功能的影响。方法:对2012年6月至2016年8月在中南大学湘雅二医院行全髋关节置换术的68例股骨头重度坏死(Ficat III,IV期)患者术中应用软组织松解及髋臼重建术。全髋关节置换术均采用的后外侧入路。通过清除瘢痕组织和增生骨赘,充分松解外展肌群腱性止点、内收肌群腱性止点及髋臼周围软组织,在解剖位置上重建髋臼并延长患肢长度。术后1年行Harris评分、患侧髋关节X线正侧位片检查及双下肢全长X线片检查。结果:术后随访1.0~5.5年。68例患者股骨头均恢复至正常解剖位置,患肢长度延长1.5~3.5 cm,无坐骨神经损伤发生,术后1年Harris评分从术前的38.6±7.5上升至78.2±5.7(P=0.029)。结论:在股骨头重度坏死患者的全髋关节置换术中,可以应用软组织松解及髋臼重建术来保证髋臼窝达到解剖重建,从而改善外展肌的功能。

Objective:To explore the effect of application of soft tissue loosening and acetabular reconstruction in hip replacement for patients with severe femoral head necrosis on joint function.Methods:From June 2012 to August 2016,68 patients with severe femoral head necrosis(Ficat III,IV)underwent total hip replacement with soft tissue release and acetabular reconstruction at the Second Xiangya Hospital of Central South University.Total hip replacement is performed by the posterolateral approach.The acetabulum was rebuilt and the length of the affected limb was prolonged after clearing the scar tissue,proliferating the epiphysis,releasing the abductor muscle group and the adductor muscle group,dissecting the soft tissue around the acetabulum.One year after surgery,Harris score,X-ray positive lateral radiograph for the affected side and full-length X-ray examination for both lower extremities were performed to evaluate the curative effect.Results:The postoperative follow-up time ranged from 1.0 to 5.5 years.All patients’femoral heads returned to normal anatomical position and the affected limb length was restored to 1.5–3.5 cm;all patients did not damage the sciatic nerve.The Harris scores for 68 patients increased from 38.6±7.5 to 78.2±5.7(P=0.029)in the first year after surgery.Conclusion:During hip replacement surgery for severe femoral head necrosis,soft tissue dissection and acetabular reconstruction can be used to ensure anatomical reconstruction for the acetabular fossa and to improve abductor function.