Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
Can J Surg. 2013 Feb;56(1):41-6. doi: 10.1503/cjs.032510.
The proportion of total hip arhtoplasties (THAs) associated with corticosteroid use is uncertain, and the mechanisms of corticosteroid-induced osteonecrosis remain unknown. We sought to evaluate the clinical and radiographic outcomes, complications and satisfaction with THA among patients with corticosteroid-induced osteonecrosis.
We retrospectively assessed functional outcome at a minimum 1-year follow-up using the Western Ontario and MacMaster Universities Arthritis Index (WOMAC); Oxford Hip Score; Short Form (SF)-12; University of California, Los Angeles (UCLA) Activity; and patient satisfaction scores.
We included 31 patients (35 hips). The average follow-up was 20 (range 12- 55) months, and the average age at surgery was 47 (range 19-78) years. At follow-up, patients showed significant improvement in all 4 components of the WOMAC (means: function 84, stiffness 75, pain 86, global 84), Oxford-12 (mean 83) and SF-12 (means: mental 40 and physical 48) scores. However, there was no significant improvement in the UCLA Activity scores. Mean patient satisfaction scores were good for pain relief (86), function (80), recreation (77.5) and overall results of surgery (86). Radiographic review at follow-up showed that all components were well fixed with no evidence of loosening. The complication rate was high (17%), with 6 complications in 5 patients (6 of 35 hips). Four patients (4 of 35 hips; 11%) required reoperations.
Total hip arthroplasty in patients with corticosteroid-induced osteonecrosis of the femoral head is successful in reducing pain and improving function; however, the rate of complications and reoperation is high.
与皮质类固醇使用相关的全髋关节置换术（THA）的比例尚不确定，皮质类固醇诱导性骨坏死的机制仍不清楚。我们旨在评估皮质类固醇诱导性股骨头坏死患者的 THA 的临床和影像学结果、并发症和满意度。
我们使用 Western Ontario 和 MacMaster 大学关节炎指数（WOMAC）；牛津髋关节评分；简短表格（SF）-12；加利福尼亚大学洛杉矶分校（UCLA）活动；和患者满意度评分，对至少 1 年的随访时的功能结果进行回顾性评估。
我们纳入了 31 名患者（35 髋）。平均随访时间为 20 个月（范围 12-55 个月），手术时的平均年龄为 47 岁（范围 19-78 岁）。随访时，患者在 WOMAC 的所有 4 个组成部分（功能 84、僵硬 75、疼痛 86、整体 84）、Oxford-12（平均 83）和 SF-12（心理平均 40、身体平均 48）评分均有显著改善。然而，UCLA 活动评分没有显著改善。患者满意度评分平均为疼痛缓解（86）、功能（80）、娱乐（77.5）和手术整体结果（86）良好。随访时的影像学检查显示所有组件均固定良好，无松动迹象。并发症发生率较高（17%），5 名患者（35 髋中的 6 髋）有 6 例并发症。4 名患者（35 髋中的 4 髋；11%）需要再次手术。
在患有皮质类固醇诱导性股骨头坏死的患者中进行全髋关节置换术可以成功减轻疼痛和改善功能；然而，并发症和再次手术的发生率较高。
