摘要
目的探讨半髋表面置换术治疗股骨头缺血性坏死的近、中期疗效与股骨假体的柄干角和下沉的关系。方法41例(48髋)金属半髋表面置换患者手术时的平均年龄为36.7岁,随访至少3年。均诊为股骨头缺血性坏死,FicatⅢ期35髋、Ⅳ期13髋;其髋臼相对正常。在术后骨盆X线片上测量股骨假体的柄干角,观察其下沉情况。结果全部病例均获随访,平均5.2年(3～8年)。平均的UCLA髋关节功能评分明显改善(P=0.001),5年生存率为83%。按UCLA评分标准,FicatⅢ期35髋术后的满意率为88.6%;Ⅳ期13髋术后的满意率为69.2%(P<0.05)。8髋(FicatⅢ期、Ⅳ期各4髋)疗效差,归为失败组。计算机辅助的X线片分析显示6髋的股骨假体有明显下沉(其柄干角小于130°),2髋的髋臼有破坏(1髋柄干角为128°,1髋为136°)。疗效好的40髋(成功组)的平均柄干角为139°,而失败组的平均柄干角为127°(P<0.05)。失败组中,6髋假体头中心和假体柄尖的下沉分别为5.02mm和4.85mm,其柄干角均小于130°;而成功组假体头中心和假体柄尖的下沉仅为1.48mm和1.04mm(P<0.05)。柄干角小于130°者其发生不良后果的机会增加7.1倍。计算机辅助的X线片分析显示股骨假体超过2mm下沉的时间为19.5个月,临床出现症状的时间为35.6个月(P<0.01)。结论金属半髋表面置换术的近、中期疗效满意。较大的股骨假体的柄干角可以减少股骨头颈区域的压力,从而可以减少下沉,提高存活率。运用计算机辅助的X线片分析可以预测假体的失败。
Objective To evaluate the short and middle-term outcome of metal surface hemiarthroplasty in treatment of femoral head osteonecrosis. Methods Forty-one patients （forty-eight hips） with average age of 40 years were performed hemi-arthroplasties and followed up for minimum 3 years. Thirty-five cases were at the stage of Ficat Ⅲ and 13 at the stage Ⅳ and their acetabular were relatively normal. Measurements of the hip reconstruction were made on the anteroposterior pelvic radiograph assisted with computer. The outcome of metal surface hemi-arthroplasty and the correlation between the orientation of the femoral component and the migration of implant was evaluated. Results The mean duration of follow-up was 5.2 years. The average UCLA hip score was improved significantly （P〈0.01） and the five-year survival rate of prosthesis was 83%. The paitents＇ satisfaction rate was 88.6% from 35 cases at Ficat stage Ⅲ, 69.2% for thirteen at Ficat stage Ⅳ （P〈0.05）. Eight hips （4 hips at Ficat Ⅲ, 4 hips at Ficat Ⅳ） had defined as failed group. Of eight hips defined as failed group, 7 had a lower than angle of 130°, 6 of which had a significant migration. Hips with a less than angle of 130° had an adverse outcome by a factor of 7.1 （P〈 0.01）. Six patients in failed group had a mean migration of 5.02 mm and 4.85 mm for the centre of the head and the tip of the stem, respectively （P〈 0.05） in compared with normal group. In the loosened group, the mean time to migration greater than 2 mm was earlier than the onset of clinical symptoms, 19.5 versus 35.6 months （P〈 0.01）, respectively. Conclusion Metal surface hemi-arthroplasty of the hip had a satisfactory resuh in the treatment of femoral head osteonecrosis in young patients. Optimizing the femoral stem-shaft angle toward a valgus orientation during the preparation of the femoral head is important for surface arthroplasty.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第12期716-720,共5页
Chinese Journal of Orthopaedics
关键词
股骨头坏死
髋假体
治疗结果
Femur head necrosis
Hip prosthesis
Treatment outcome
