关节病髋臼骨缺损的股骨头植骨初次全髋置换

Primary total hip arthroplasty combined with bone autograft of femoral head for end-stage hip arthropathy with acetabu⁃lar bone defect

[目的]探讨初次全髋关节置换术自体股骨头植骨治疗终末期关节病伴髋臼骨缺损的临床疗效。[方法]2010年7月—2016年6月,对14例终末期髋关节病伴髋臼骨缺损患者行自体股骨头植骨全髋关节置换术。随访观察临床与影像结果。[结果]所有患者均顺利完成手术,术中无严重并发症。14例患者随访3~9年,平均(5.81±2.86)年。与术前相比,末次随访时患者临床测量双下肢长度差显著减小(P<0.05);髋关节活动度,包括外展、内收、屈曲、外旋和内旋均显著增加(P<0.05),Harris评分显著增加(P<0.05)。影像方面,与术前相比,末次随访时股骨头中心上移显著减少(P<0.05)。至末次随访,均未出现假体松动、植骨块吸收、骨溶解、臼杯假体移位、股骨柄下沉等不良影像征象。[结论]初次全髋关节置换术中采用自体股骨头重建髋臼内上方骨缺损,疗效满意,并发症较少。

[Objective]To explore the clinical outcomes of primary total hip arthroplasty combined with bone autograft of femoral head for end-stage hip arthropathy with acetabular bone defect.[Method]From July 2010 to June 2016,14 patients underwent primary total hip arthroplasty combined with bone autografting of femoral head for end-stage hip arthropathy with acetabular bone defect.Follow-up observa⁃tion was conducted to evaluate the clinical and imaging consequences.[Results]All patients had operation performed successfully without serious complications during the operation.The 14 patients were followed up for 3~9 years,with an average of(5.81±2.86)years.Compared with those preoperatively,the clinically measured low limb length discrepancy significantly reduced(P<0.05),whereas the hip range of mo⁃tion,including abduction,adduction,flexion,external rotation,and internal rotation,significantly increased(P<0.05),additionally,the Har⁃ris score increased significantly at the latest follow-up(P<0.05).In terms of imaging evaluation,the upward displacement of hip rotation center significantly reduced at the last follow-up compared with that preoperatively(P<0.05).No prosthetic loosening,bone graft absorp⁃tion,osteolysis,and displacement of the acetabular component,femoral stem subsidence and other adverse imaging signs were noted in any⁃one of them at the latest follow-up.[Conclusion]The bone autografting of femoral head to reconstruct the acetabular bone defect in primary total hip arthroplasty does achieve satisfactory clinical results with fewer complications.