Beaulé Paul E, Matta Joel M, Mast Jeffrey W
Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA, USA.
J Am Acad Orthop Surg. 2002 Jul-Aug;10(4):249-58. doi: 10.5435/00124635-200207000-00003.
The management of young adults with severe osteoarthritis of the hip remains a problem because of the increased failure rates of total hip arthroplasty (THA) as well as the prospect of multiple revisions in this population. Although hip arthrodesis is not perceived favorably as an alternative by most orthopaedic surgeons or patients because of the presumption of less than optimal functional outcomes, it is a viable technique, especially for younger patients with a recent history of local infection and/or trauma. With current internal fixation techniques, a fusion rate >80% can be achieved with maximal preservation of bone stock. Proper patient selection and optimal arthrodesis position (flexion of 20 degrees to 30 degrees, adduction of 5 degrees, external rotation of 5 degrees to 10 degrees, and limb-length discrepancy <2 cm) are essential for a successful, long-term result. Back and ipsilateral knee pain are the most common complaints leading to secondary conversion of a hip fusion to a THA. Symptoms improve markedly after conversion. Survivorship of the conversion THA is comparable to that of a primary THA when the patient is older than 50 years of age and multiple surgical procedures have been avoided. However, the procedure can be technically challenging and has a high risk of postoperative complications.
由于全髋关节置换术（THA）失败率增加以及该人群多次翻修的可能性，年轻重度髋关节骨关节炎患者的治疗仍然是一个难题。尽管由于人们认为髋关节融合术功能结局欠佳，大多数骨科医生和患者都不太看好它作为一种替代方案，但它是一种可行的技术，尤其适用于近期有局部感染和/或创伤史的年轻患者。采用当前的内固定技术，可以在最大限度保留骨量的情况下实现超过80%的融合率。正确的患者选择和最佳的融合位置（屈曲20度至30度、内收5度、外旋5度至10度以及肢体长度差异<2厘米）对于取得成功的长期效果至关重要。背部和同侧膝关节疼痛是导致髋关节融合术二次转换为THA的最常见主诉。转换后症状明显改善。当患者年龄超过50岁且避免了多次手术时，转换THA的生存率与初次THA相当。然而，该手术在技术上可能具有挑战性，且术后并发症风险较高。
