Liu Jun, Zhen Ping, Zhou Sheng-Hu, Tian Qi, Chen Hui, Wang Wei, He Xiao-le, Li Xu-Sheng
Department of Orthopaedics, General Hospital of Lanzhou Command, Lanzhou 730000, Gansu, China.
Department of Orthopaedics, General Hospital of Lanzhou Command, Lanzhou 730000, Gansu, China;
Zhongguo Gu Shang. 2018 Feb 25;31(2):129-134. doi: 10.3969/j.issn.1003-0034.2018.02.007.
To evaluate the manipulation technique and clinical outcome of Tri-Lock bone preservation stem for acetabular protrusion combined with shorten defect of femoral head and neck.
From January 2013 to December 2015, 10 patients(12 hips) with acetabular protrusion combined with shorten defect of femoral head and neck were treated with total hip arthroplasty(THA) including 5 males and 5 female with an average age of(51.6±3.0) years old ranging from 42.5 to 67.5 years old. The acetabular prostheses were all biological prosthesis with the ceramic lining, the whole ceramic femoral head was used in all the cases. The posterior-lateral hip incision was adopted in the surgery. The follow-up was carried out in 12 months after the surgery, and later once a year. The Harris score system in growth of femoral side described was used to assess the joint function of the patients before and after the surgery.
Ten patients were followed up for 8 to 48 months with an average of 33.0±3.5. All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. The biological compression of the acetabulum and the stem of the femur was realized immediately after operation in 10 patients(12 hips). X-ray at 3 months after the operation showed bone growth were extended in a wide range, which could achieve bone fixation, no loosening and re-invagination. The range of hip movement increased from (45.8±7.5)° to (90.0±6.5)° at the final follow-up, with flexion increased to (89.0±6.0)°, abduction increased to (35.5±7.3)° and internal rotation increased to(31.8±6.6)°, the outer rotation increased to(32.6±5.2)°. The mean Harris scores had improved from 45.7±7.5 pre-operatively to 93.5±8.0 post-operatively, there was statistically significant difference between before and after surgery (=144.832, <0.05).
Combined with acetabular treatment, Tri-Lock bone retention of the femoral stem in the treatment of femoral head and neck with shortening of the acetabular retraction and severe hip joint soft tissue contracture in patients, could be well pressed and retained more bone. The reconstruction of the acetabulum and the delamination of soft tissue are required during the operation. The results were safe and satisfactory in the middle and short term follow-up.
评估Tri-Lock骨保留柄治疗髋臼前突合并股骨头颈缩短缺损的操作技术及临床疗效。
2013年1月至2015年12月，对10例（12髋）髋臼前突合并股骨头颈缩短缺损患者行全髋关节置换术（THA），其中男5例，女5例，平均年龄（51.6±3.0）岁，年龄范围42.5至67.5岁。髋臼假体均为带陶瓷内衬的生物型假体，所有病例均采用全陶瓷股骨头。手术采用后外侧入路。术后12个月进行随访，之后每年随访1次。采用所述股骨侧生长的Harris评分系统评估患者手术前后的关节功能。
10例患者随访8至48个月，平均33.0±3.5个月。所有切口愈合良好，未发生股骨骨折、感染、脱位及神经血管损伤等并发症。10例（12髋）患者术后即刻实现了髋臼和股骨干的生物性压配。术后3个月X线显示骨生长广泛，可实现骨固定，无松动及再内陷。末次随访时髋关节活动范围由（45.8±7.5）°增加至（90.0±6.5）°，其中屈曲增加至（89.0±6.0）°，外展增加至（35.5±7.3）°，内旋增加至（31.8±6.6）°，外旋增加至（32.6±5.2）°。Harris平均评分由术前的45.7±7.5提高至术后的93.5±8.0，手术前后差异有统计学意义（=144.832，<0.05）。
Tri-Lock股骨柄结合髋臼处理治疗髋臼内陷及严重髋关节软组织挛缩伴股骨头颈缩短患者，可良好地实现压配并保留更多骨质。术中需进行髋臼重建及软组织分层处理。中短期随访结果安全、满意。
