Li Feng, Tian Hua, Zhang Ke, Liu Yan
Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1188-91.
To evaluate the clinical results of the femoral reconstruction technique in patients with proximal femoral deformity in total hip arthroplasty.
Between March 2004 and June 2009, total hip arthroplasty procedures were performed on 25 patients (26 hips) with hip joint disease and proximal femoral deformity, including primary osteoarthritis of the hip joint (2 hips), developmental dysplasia of the hip (8 hips), traumatic arthritis of the hip (14 hips), and tuberculosus arthritis of the hip (2 hips). There were 10 males (10 hips) and 15 females (16 hips), with an average age of 64 years (range, 42-82 years). The disease duration was 10 months to 25 years (mean, 10.6 years). The Harris score was 44.2 +/- 5.1, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 45.0 +/- 2.7 before operation. According to Berry's classification system of primary disease, 8 hips were classified as developmental dysplasia of hip, 7 hips as malunion of fracture, 2 hips as chronic tuberculosis, 2 hips as slipped femoral epiphysis, 1 hip as previous subtrochanteric osteotomy, 1 hip as previous shelf operation of the acetabulum, and 5 hips as previous internal fixation; according to the anatomic site of the deformity, there were 5 hips of greater trochanter, 10 hips of femoral neck level, 10 hips of metaphyseal level, and 1 hip of diaphysis.
All wounds healed by first intention. Deep venous thrombosis occurred in 3 patients within 1 week, and were cured with braking and anticoagulant therapy. Bursal synovitis of great trochanter occurred in 1 patient after 6 weeks, and was eased after taking drugs for pain relief. All patients were followed up 1 year and 6 months to 6 years, with an average of 3 years and 3 months. The Harris score and WOMAC score at last follow-up were 88.4 +/- 3.6 and 82.0 +/- 5.2 respectively, showing significant differences when compared with preoperative scores (P < 0.05). The X-ray films at last follow-up showed good location of prosthesis and no loosening expect 1 patient who had aseptic loosening and was given revision at 8 months postoperatively.
Proximal femoral deformity classification will contribute to the choice of prosthesis and surgical strategy, thus the good results of femoral reconstruction and clinical results would be obtained.
评估全髋关节置换术中股骨近端畸形患者采用股骨重建技术的临床效果。
2004年3月至2009年6月，对25例（26髋）患有髋关节疾病和股骨近端畸形的患者实施全髋关节置换手术，其中包括髋关节原发性骨关节炎（2髋）、髋关节发育不良（8髋）、髋关节创伤性关节炎（14髋）以及髋关节结核（2髋）。男性10例（10髋），女性15例（16髋），平均年龄64岁（范围42 - 82岁）。病程为10个月至25年（平均10.6年）。术前Harris评分为44.2±5.1，西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分为45.0±2.7。根据Berry原发性疾病分类系统，8髋为髋关节发育不良，7髋为骨折畸形愈合，2髋为慢性结核，2髋为股骨头骨骺滑脱，1髋为既往转子下截骨术，1髋为既往髋臼加盖手术，5髋为既往内固定术；根据畸形的解剖部位，大转子处5髋，股骨颈水平10髋，干骺端水平10髋，骨干1髋。
所有伤口均一期愈合。3例患者在1周内发生深静脉血栓，经制动和抗凝治疗后治愈。1例患者在6周后出现大转子滑囊炎，经服用止痛药物后缓解。所有患者随访1年6个月至6年，平均3年3个月。末次随访时Harris评分和WOMAC评分分别为88.4±3.6和82.0±5.2，与术前评分相比差异有统计学意义（P < 0.05）。末次随访时X线片显示假体位置良好，除1例患者术后8个月出现无菌性松动并接受翻修外，其余均无松动。
股骨近端畸形分类有助于假体选择和手术策略的制定，从而获得良好的股骨重建效果和临床结果。
