摘要
目的评价Zweymuller双锥面螺旋臼及加长矩形柄在人工全髋关节翻修中的临床应用效果.方法自1996年11月～2001年1月,对55例56髋行髋关节翻修手术,男26例,女29例;年龄30～80岁,平均59岁.初次人工髋关节置换前诊断为股骨颈骨折27例,股骨头缺血性坏死22例,类风湿性关节炎2例,强直性脊柱炎3例,髋关节创伤性关节炎1例.初次行股骨头置换18例19髋,其中骨水泥固定3例3髋,非骨水泥固定15例16髋;全髋关节置换37例37髋,其中骨水泥固定25髋,非骨水泥固定12髋.术后20髋因髋关节严重疼痛、36髋因无菌性假体松动行关节翻修术.翻修手术中,16髋行髋臼植骨术,其中自体碎屑植骨15髋,异体大块植骨1髋.所有病例均使用双锥面螺旋臼及加长矩形柄系统固定.术后随访时间为5～63个月,平均31个月.结果术后随访32例33髋,所有患者髋关节基本无疼痛,X线片示髋臼和股骨柄假体位置满意,无松动和感染征象,髋臼植骨处愈合良好.3例股骨柄假体正位X线片仅I区出现约1 mm宽的透亮带,临床检查无松动迹象.Harris评分由术前的平均40.6分(10～71分)提高到术后的平均80.4分(55～97分).结论对于髋臼环完整需行人工髋关节翻修术的病例,使用Zweymuller双锥面螺旋臼及加长矩形柄系统固定牢固,临床效果满意.
Objective To evaluate the clinical results of revision hip re placements using Zweymüller Biconical cementless cup and SLR stem system. Metho ds Revisional operation of 56 hips in 55 patients was performed from November 19 96 to December 2001. There were 26 males and 29 females with an average age of 5 9 years (range, 30 to 80 years). The primary diagnosis consisted of femoral neck fracture in 27, aseptic femoral head necrosis in 22, rheumatoid arthritis in 2, ankylosing spondylitis in 2, and other condition in 1. The primary operation in cluded femoral head replacement in 18 (19 hips), and total hip replacement in 37 (37 hips). The causes of revision were pain for 26 hips, and definite aseptic l oosening for 30 hips. Of 37 total hip replacements, 35 were demonstrated with ac etabular component loosening, which were type Ⅰ in 19, type Ⅱ in 15 and type Ⅲ in 1 according to Gustilo classification system; 36 of femoral component loos ening were divided into type Ⅰ in 25 and type Ⅱ in 11. In the patients with pr imary operation of femoral head replacement, all were revised for acetabular wea r with femoral component loosening of type Ⅰ. Structural bone allografts was us ed in 1 patient with acetabular component loosening of type Ⅱ, and morselized a llografts were applied in 15 patients with acetabular component loosening of typ e Ⅲ. Results Thirty-six patients were followed up with a mean of 31 months (ran ge, 5 to 63 months). All patients were free from pain and satisfied with the res ult of operation. Radioluscent line of acetabular component and radiographic sub sidence of stem were not found in any of the hip joints. Bone graft was healed. Acetabular heterotopic bone formation (Brooker Ⅰ ) was noted in 3 patients. Th e Harris hip score increased from preoperative 40.6 points(10-71 points) to pos toperative 80.4 points(55-97 points). Radiolucency of 1 mm width was seen in 3 femoral stems with no clinical loosening relevance. Conclusion The clinical resu lts showed that the system of cementless THR of Zweymüller type in revisional o peration is proved to be suitable to both cemented and cementless hip joint repl acements.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第12期743-746,共4页
Chinese Journal of Orthopaedics
