保留股骨颈人工全髋关节置换术治疗髋关节疾病

Ding Shaohua, Zheng Kang

Department of Orthopaedics, Ningbo Medical Center, Li Huili Hospital, Ningbo Zhejiang, 315000, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):1-4.

OBJECTIVE

To evaluate the therapeutic outcome of artificial total hip arthroplasty (THA) with collum femoris preserving for hip joint disease in young and middle-aged patients.

METHODS

From March 2002 to March 2005, 26 cases (31 hips) of hip joint disease were treated with artificial THA with collum femoris preserving, including 19 males (23 hips) and 7 females (8 hips) and aged 32-48 years with an average of 37 years. In 31 hips, 17 left hips and 14 right hips were involved. There were 9 cases of osteoarthritis of the hip joint caused by avascular necrosis of the femoral head (ANFH), 7 cases of ANFH, 3 cases of femoral head necrosis caused by dysplasia of acetabular, 1 case of osteoarthritis of the hip joint caused by ankylosing spondylitis, and 2 cases of rheumatoid arthritis; the course of disease was 2-11 years (5.6 years on average). Two cases of femoral neck fracture (Garden IV), and 2 cases of non-union femoral neck fractures (1 for Garden III and 1 for Garden IV), the course of disease was 5 days, 24 months, and 26 months. The prime symptoms were pain, difficult walk and limp. All patients were taken X-ray to exclude osteoporosis.

RESULTS

The right distal femur prosthesis of a bilateral patient cracked owing to excessive amputation of collum femoris, and fracture healed after symptomatic treatment. All the incisions healed by first intention and no complications occurred. All patients were followed up for 4-7 years, with an average of 5.6 years. One case had poor hip function because he did not follow rehabilitation procedure, and the others achieved good outcome with normal gait. One case complained of persistent pain 6 months after operation, and was relieved by administration of some non-steroidal anti-inflammatory drugs and anti-osteoporosis drugs 6 months later. The X-ray films after operation and at last follow up showed good location of prosthesis and no bone resorption. Harris score at last follow-up was 91.31 +/- 0.77, and it was significantly higher than that before operation (50.88 +/- 0.90), (P < 0.05). The excellent and good rate was 93.5% (excellent in 11 hips, good in 18 hips, and fair in 2 hips).

CONCLUSION

Artificial THA with collum femoris preserving can retain more bone, be easier for revision, and has an excellent outcome.

目的

评估保留股骨颈人工全髋关节置换术（THA）治疗中青年髋关节疾病的疗效。

方法

2002年3月至2005年3月，采用保留股骨颈人工THA治疗26例（31髋）髋关节疾病患者，其中男性19例（23髋），女性7例（8髋），年龄32 - 48岁，平均37岁。31髋中，左侧17髋，右侧14髋。股骨头缺血性坏死（ANFH）致髋关节骨关节炎9例，ANFH 7例，髋臼发育不良致股骨头坏死3例，强直性脊柱炎致髋关节骨关节炎1例，类风湿关节炎2例；病程2 - 11年（平均5.6年）。股骨颈骨折（Garden IV型）2例，股骨颈骨折不愈合2例（Garden III型1例，Garden IV型1例），病程分别为5天、24个月、26个月。主要症状为疼痛、行走困难和跛行。所有患者均行X线检查以排除骨质疏松。

结果

1例双侧患者右侧股骨远端假体因股骨颈截骨过多出现裂纹，经对症处理后骨折愈合。所有切口均一期愈合，未发生并发症。所有患者随访4 - 7年，平均5.6年。1例患者因未遵循康复程序髋关节功能差，其余患者步态正常，疗效良好。1例患者术后6个月诉持续疼痛，6个月后给予一些非甾体抗炎药和抗骨质疏松药物后缓解。术后及末次随访X线片显示假体位置良好，无骨吸收。末次随访Harris评分为91.31±0.77，显著高于术前（50.88±0.90），（P < 0.05）。优良率为93.5%（优11髋，良18髋，可2髋）。