钽棒置入保髋失败股骨头坏死的全髋置换术

Total hip arthroplasty following failure of tantalum rod implantation for avascular necrosis of femoral head

[目的]与初次全髋关节置换术(total hip arthroplasty, THA)比较,评价股骨头缺血性坏死钽棒置入手术失败后再行THA的临床结果。[方法] 2013年1月~2017年12月,钽棒置入术后失败的患者行THA的44例患者列为保髋失败组,选择同期既往未行手术治疗初次THA治疗股骨头缺血坏死42例为初次置换组;比较两组围手术期、随访和影像资料。[结果]保髋失败组手术时间、切口长度、术中失血量和自体血回输量均显著大于初次置换组(P<0.05),两组间术后下地时间和住院时间的差异均无统计学意义(P>0.05)。随访期间,两组患者均未发生假体周围骨折、脱位或不稳定、弹响等并发症。与术后3个月相比,末次随访时两组患者的疼痛视觉模拟评分、髋关节屈曲活动度评分和Harris评分均无显著变化(P>0.05)。相应时间点,两组间VAS、髋关节屈曲ROM和Harris评分的差异均无统计学意义(P>0.05)。影像方面,两组在髋臼外展角、前倾角、股骨长度差方面差异无统计学意义(P>0.05)。至末次随访时,两组患者均无假体松动。[结论] THA治疗钽棒保髋术后失败患者临床和影像学效果满意。

[Objective] To evaluate the clinical outcomes of total hip arthroplasty(THA) following failure of tantalum rod implantation for avascular necrosis of femoral head(ANFH) by comparison with the primary THA. [Methods] From January 2013 to December 2017, a total of 44 patients who received THA following failure of tantalum rod implantation(FTRI) for ANFH were termed as the FTRI group, while 42 patients who underwent primary THA without previous surgical intervention for ANFH in the same period were selected as the pTHA group. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] The FTRI group consumed significantly longer operation time, associated with significantly greater intraoperative blood loss and volume of salvage of shed blood than the pTHA group(P<0.05), however, no statistical differences were noticed regarding postoperative drainage, time to return ambulation and hospital stay between the two groups(P>0.05). During follow-up period, no periprosthetic fracture, dislocation, instability and snapping hip happened in any patient of both groups. Compared with those at 3 months postoperatively, the VAS score, flexion-extension ROM and Harris score remained unchanged at the latest follow-up in both groups(P>0.05). In addition, no statistically significant differences between the two groups in aforesaid parameters were found at any matching time point(P>0.05). In term of radiographic assessment, no statistical differences were noted between the two groups in the cup abduction, anteversion and leg length discrepancy measured on images between the two groups(P>0.05). To the latest follow-up, no prosthetic loosening was seen in any patient of both groups. [Conclusion] THA also achieve satisfactory clinical and imaging results for the ANFH patients who have failed to preserve hip with tantalum rod implantation.