生物型假体全髋关节置换术治疗Perthes病后遗骨关节炎的中期随访研究

Cementless total hip arthroplasty in treatment of residual osteoarthritis of Perthes’ disease: A mid-term follow-up results

背景:Perthes病又称儿童股骨头缺血性坏死,是一种自愈自限性疾病,但病因不清,后遗股骨头畸形。部分病例成年后发生严重的髋关节骨关节炎,通过全髋关节置换术的治疗,以期改善生活质量。目的:观察生物固定型假体重建在全髋关节置换术治疗Perthes病后遗症的中期临床和影像学随访结果。方法:回顾性分析2012年1月至2016年12月,因Perthes病继发终末期髋骨关节炎而行全髋关节置换术的20例(20髋)患者的临床资料。年龄26~72岁,平均(51.5±11.3)岁。全部患者的股骨侧和髋臼侧均采用生物型假体进行重建,其中股骨侧8髋使用组配式假体。采用Harris髋关节评分进行疗效评价。结果:患者全部获得随访,随访时间为25~72个月,平均(48.4±7.9)个月。术前Harris髋关节评分23~38分,平均(30.2±3.7)分,末次随访时Harris髋关节评分71~97分,平均(85.2±7.8)分,差异有统计学意义(P<0.05)。术前大转子相对高度平均为41.6%±18.3%,术后平均为71.4%±54.5%,术后较术前增高(P<0.001)。术前双下肢长度差值为9~60 mm,平均(37.5±14.4)mm,术后为-10~31 mm,平均(7.4±10.8)mm,术后较术前降低(P<0.001)。术后4例患者仍然存在中度至重度跛行。围手术期并发症包括坐骨神经损伤2例和术中股骨矩骨折4例。结论:采用生物固定型假体全髋关节置换术治疗Perthes病后遗症可获得良好的中期临床和影像学结果,部分畸形严重病例需要采用组配式假体进行股骨侧重建。

Background:Perthes’disease is also called ischemic necrosis of the femoral head in children.It is a self-healing and self-limiting disease,but its etiology is unclear.The residual femoral head deformity often occurs.In some cases,severe hip osteoarthritis occurs in adulthood and is treated by total hip arthroplasty to improve quality of life.Objective:To evaluate medium-term clinical and radiographic results of total hip arthroplasty(THA)in treatment of sequelae of Perthes’disease.Methods:Between January 2012 and December 2016,data of 20 patients(20 hips)with hip arthritis of terminal stage diagnosed as sequelae of Perthes’disease were retrospectively reviewed.All patients were treated with THA with an average age of(51.5±11.3)years(range,26-72 years).Cementless cups and stems were inserted in all hips.On the femoral side 8 hips were reconstructed by modular stems.Clinical results were evaluated by Harris hip score.Results:All patients were followed up for25-72 months with an average of(48.4±7.9)months.The average Harris Hip score increased from preoperative 30.2±3.7(range,23-38)to 85.2±7.8(range,71-91)at the final follow-up.The mean relative height of greater trochanter was 41.6%±18.3%before operation and 71.4%±54.5%after operation and the difference was statistically significant(P<0.001).Lower limb length difference was(37.5±14.4)mm(range,9-60 mm)before operation and(7.4±10.8)mm(range,-10-31 mm)after operation,and the difference was statistically significant(P<0.001).There were 4 patients with moderate to severe claudication after the operation.Perioperative complications included 2 patients of sciatic nerve injury and 4 patients of intraoperative calcar femorale fracture.Conclusions:Cementless total hip arthroplasty in treatment of residual osteoarthritis of Perthes’disease can achieves good medium-term clinical and radiographic results.Some patients with severe deformities require the modular stems for femoral reconstruction.