一期双侧全髋关节置换术的临床报告

目的探讨一期双侧人工全髋关节置换术的疗效。方法对10例(20髋)患者行双侧一期全髋关节置换术。其中男8例,女2例;年龄25~65岁;病程1~30年。结果手术时间3h 25min~5h 30min,术中输血600~1600ml。随访6个月~5年3个月、平均18个月,除1例因心脏病死亡外,其余患者均能独立行走,生活自理。结论一期双侧全髋关节置换术是一种安全有效的手术。充分的术前准备,慎重选择病例,严格的假体安装标准,有效的风险防范,是手术成功的关键。     

全髋关节表面置换术治疗股骨头缺血性坏死初步临床观察

目的 探讨全髋关节表面置换术治疗股骨头缺血性坏死(ANFH)的可行性及临床疗效.方法 对26例ANFH患者行全髋关节表面置换术,术后规范功能锻炼.定期临床随访,并按相关标准评价其疗效.结果 所有患者切口均一期临床愈合.26例均获得随访,时间4～14个月.早期无股骨颈骨折、感染、关节脱位、血管神经损伤、深静脉栓塞、异位骨化等并发症.术后髋关节活动度明显改善,术后Harris评分由术前平均39分上升至平均93分.影像学检查假体位置良好.患者生活质量均明显提高.结论 全髋关节表面置换术治疗ANFH患者,具有较多优势,初步临床效果满意.     

全髋关节表面置换术治疗股骨头坏死近期结果

目的 对全髋表面置换术治疗股骨头坏死的近期疗效作一小结，了解影响疗效的因素。方法 自2000年10月～2004年12月，对15例18髋FicatⅢ、Ⅳ期股骨头坏死进行了全髋关节表面置换术，平均年龄39岁（23～49岁）。手术方法按照Amstutz和Nelson提出的标准方法进行，术后进行定期随访。结果 平均随访3．5年（6～50个月），无股骨颈骨折、无脱位、无感染。1例髋臼假体周围发现有透亮带，1例因股骨头假体位置不佳已行翻修。术前平均Harris评分30分，术后为90分，最近一次随访平均评分93分（89～98分）。评价：优16髋，良1髋，差1髋。结论全髋关节表面置换术是治疗FicatⅢ、Ⅳ期且年龄较轻股骨头缺血性坏死的有效方法，近期随访结果满意。     

全髋关节表面置换术的发展

全髋关节表面置换术（total hip surface replacement，THSR）的原理是用髋臼帽及股骨头杯覆盖和重建髋关节疾病患者股骨头和（或）髋臼表面已被破坏而切除的关节面，以恢复髋关节功能。该手术适用于髋关节畸形较轻、局部骨质好、股骨近端畸形或有其他金属内固定物、用带柄假体有困难的患者尤其是年轻、将来有可能需行全髋置换术的患者，主要适合年轻的Ⅲ期及早Ⅳ期股骨头缺血性坏死患者，骨性关节炎、创伤性关节炎和类风湿性关节炎等患者。与全髋关节置换术相比，该手术具有明显的优势：①最大限度地保留髋关节的骨量，为全髋关节置换术留有余地；②维持了髋关节正常的解剖关系，较少发生肢体不等长情况；③术后稳定性高，极少脱位；④植入物体积小，易于取出，翻修手术难度降低：⑤表面置换并不会破坏股骨头的血运；⑥最大程度地维持正常的人体生物力学，适合东方人的生活方式。     

金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死的短期临床效果

目的探讨新一代的金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死（FicatⅢ、Ⅳ）的短期临床效果。方法对28例（33髋）诊断为股骨头无菌性坏死的患者行金属对金属髋关节表面置换手术。股骨头无菌性坏死程度按照Ficat分期：Ⅲ期24例（27髋），Ⅳ期4例（6髋），手术时的平均年龄是48岁（21-77岁），其中男患者17例（60.7%），女患者11例（39.3%）。术后随访内容包括所有患者的临床及影像学资料。结果平均随访时间为24个月（11-35个月），在随访期内未发生髋关节脱位、深静脉栓塞、感染、股骨颈骨折等并发症。临床结果显示，Harris髋关节评分较术前显著提高，术后平均Harris评分为92.6分，术前平均Harris评分为48.5分。影像学资料显示所有假体在位，未观察到放射性透亮带。所有患者疼痛解除，髋关节活动度也明显改善，术后早期活动无任何受限。结论金属对金属髋关节表面置换术治疗重度股骨头坏死的早期临床效果满意，其远期效果仍有待于观察。     

计算机辅助下的小切口人工全髋关节置换术

目的探讨计算机辅助下（导航）的小切口人工全髋关节置换术（MIS—THA）的手术方法及临床意义。方法2006年3～12月对连续无选择病例22例30髋在计算机辅助下行MIS—THA，术中采用导航定位髋臼。术前、术后常规拍摄下肢全长X线片及双髋关节正位片，测定术后髋臼倾斜角。结果手术切口长7．8～10．5cm，平均8．8cm。术后X线片示髋臼倾斜角30^o～54^o，平均41．6^o，仅1例为54。，其余均在30^o-50^o范围内。结论计算机辅助下MIS—THA是一种全新的技术，可以在THA术中将髋臼假体安放的更精确，减少变异性。     

全髋关节表面置换术治疗股骨头坏死的Meta分析

目的通过综合分析已发表文献,探讨全髋关节表面置换术治疗股骨头坏死的效果及安全性。方法通过系统检索从1990年1月到2011年12月全髋关节表面置换术治疗股骨头坏死的相关文献,按照排除标准筛选后,提取需要的数据,通过循证医学Meta分析方法,加权汇总分析。结果共检出192篇相关文献检出,经过三个阶段的筛选,共有10篇被纳入分析,共有317例患者,376例髋关节,男性患者191例,女性126例,平均加权年龄为41.98岁（16～77岁）,加权平均随访时间36.69个月（6～140个月）。术后的髋关节Harris评分（92分）较术前（44分）的差异有统计学意义（t=18.07,P〈0.01）。主要并发症包括假体无菌性松动（1.06%）、异位骨化（0.80%）、疼痛（0.80%）和股骨颈骨折（0.27%）,最终翻修率为0.80%。结论全髋关节表面置换术治疗股骨头坏死是安全有效的,但需要注意其并发症。     

表面置换术治疗中青年股骨头缺血性坏死

目的探讨采用表面置换术治疗中青年股骨头坏死的临床效果。方法对11例（14髋）Ficat分期为Ⅲ期或早Ⅳ期的股骨头坏死患者采用股骨头表面置换术，并对假体的形状进行了改进，其中男7例，女4例，年龄35～49岁。对13例（16髋）Ficat分期为Ⅲ期或早Ⅳ期股骨头坏死患者采用全髋表面置换术，其中男8例，女5例，年龄23～48岁。结果股骨头表面置换术患者术后随访1～5年，髋关节Harris评分从术前平均39分增至91分；X线片示假体无松动移位，近段股骨和髋臼无骨吸收和骨溶解，髋关节间隙除1例轻度狭窄外余均无磨损征象，无1例翻修。全髋表面置换术患者术后随访6个月～3年4个月，Harris评分从术前平均30分增至93分，有1例因技术原因术后半年假体松动而进行翻修，评为失败。结论表面置换术是治疗中青年股骨头缺血性坏死较为理想的一种方法。     

影响髋关节表面置换术后关节功能恢复的多因素分析

目的探讨影响股骨头缺血性坏死患者行髋关节表面置换术后关节功能恢复的因素。方法1997年6月至2008年7月对股骨头缺血性坏死患者45例47髋行半髋关节表面置换,男25例,女20例;年龄29—49岁,平均36．6岁。应用Harris髋关节评分对疗效进行评定。研究患者的年龄、性别、体重指数、职业、病因、Ficat分期、髋部手术史、股骨假体柄干角、术后开始锻炼时间等相关因素,在单因素分析基础上应用Logistic回归模型作多因素分析。应用SPSS13．0进行统计学分析,其中Harris髋关节评分作为因变量,分为优、较好、良、差4类,其中前2类视为功能恢复满意。结果45例患者随访1—11年,平均8．6年。Harris髋关节评分：优15例,较好20例,良8例,差2例,满意率为77．8％。单因素分析结果发现患者的体重指数、Ficat分期、股骨假体柄干角、术后开始锻炼时间4个因素与髋关节功能恢复显著相关（P〈0．05）。Logistic回归发现此4个因素是影响髋关节功能恢复的主要因素。结论体重指数、Ficat分期、股骨假体柄干角、术后锻炼时间可明显影响髋关节表面置换术后功能恢复。     

全陶关节置换在晚期髋关节病年轻患者的初期疗效

目的骨关节炎和股骨头坏死年轻患者的治疗是关节外科的热点问题之一。随着近年来材料科学与生物力学的日益发展，『临床骨科对于此类病患的处理有了更为理想的选择。本试验旨在评价生物型陶瓷对需要全髋关节置换的年轻股骨头坏死及骨性关节炎的临床疗效果。方法笔者前瞻性地选取12例股骨头坏死及12例骨性关节炎行陶对陶假体全髋置换手术的病人，两组间一般资料均严格配对，其中股骨头坏死组的平均年龄是42岁，骨性关节炎组的平均年龄49岁。结果经过平均19个月的随访后，两组的髋关节功能都有显著的恢复，骨关节炎组的Harris评分（88．5）优于股骨头坏死组（86．9）。结论生物型陶对陶假体全髋置换对于年轻髋关节病患者尤其是骨关节炎患者具有一定的优势，疗效的关键在于手术操作精细。     

Metal-on-metal hip resurfacing arthroplasty

The main advantage of hip resurfacing is bone conservation for patients likely to outlive a primary conventional hip replacement. Previous attempts at hip resurfacing failed predominantly because of the consequences of a high amount of wear of thin polyethylene acetabular components and poor femoral component fixation. With correct patient selection, surgeon education, and operative technique, survivorship at five years is comparable with that of traditional hip replacements. Hip resurfacing has its own unique set of complications, including a fractured neck of the femur. It is necessary to understand the risk factors prior to performing the procedure.     

Revision of hip resurfacing arthroplasty

Metal-on-metal (MOM) hip resurfacing has become an increasingly popular treatment for young, active patients with degenerative disease of the hip, as bearing surfaces with better wear properties are now available. One proposed advantage of resurfacing is its ability to be successfully revised to total hip arthroplasty (THA). In addition, radiographic parameters that may predict failure in hip resurfacing have yet to be clearly defined. Seven MOM resurfacing arthroplasties were converted to conventional THAs because of aseptic failure. Using Harris Hip Scores (HHS) and Short Form 12 (SF-12) questionnaire scores, we compared the clinical outcomes of these patients with those of patients who underwent uncomplicated MOM hip resurfacing. In addition, all revisions were radiographically evaluated. Mean follow-up periods were 51 months (revision group) and 43 months (control group). There was no significant difference between the 2 groups' HHS or SF-12 scores. There was no dislocation or aseptic loosening after conversion of any resurfacing arthroplasty. Valgus neck-shaft angle (P < .03) was associated with aseptic failure of MOM hip resurfacing. Conversion of aseptic failure of hip resurfacing to conventional THA leads to clinical outcomes similar to those of patients who undergo uncomplicated hip resurfacing. The orientation of the femur and the components placed play a large role in implant survival in hip resurfacing. More work needs to be done to further elucidate these radiographic parameters.     

髋关节表面置换术优势与临床应用

髋关节疾病严重威胁着患者的生活质量,对于年轻患者尤甚.人工髋关节技术的日臻成熟,为广大患者提供了恢复关节功能的机会,在老年患者(＞55岁)中取得了良好的临床疗效.由于年轻患者活动量大、预期寿命长以及全髋关节置换术需要截除正常的股骨颈而改变了生物力学关系,加上假体磨损和金属疲劳导致的使用年限缩短等问题,因此传统的全髋关节置换术后可能需行多次翻修手术,翻修手术在手术并发症、假体使用年限及临床疗效等方面均明显不如初次全髋关节置换术.相对传统的全髋关节置换术,髋关节表面置换术保留了较多的骨质,因此更多地保留了关节正常的生物力学和应力转移性能,增强了关节的稳定性,使以后的翻修手术更简单易行,尤其适用于年轻患者.     

The evolution of hip resurfacing arthroplasty

Metal-on-metal hip resurfacing, a significant recent development in hip arthroplasty, preserves proximal femoral bone stock, optimizes stress transfer to the proximal femur, and offers inherent stability and optimal range of movement. The results of hip resurfacing in the 1970s and 1980s were disappointing, and the procedure was largely abandoned by the mid-1980s. The renaissance of metal-on-metal articulations for total hip arthroplasty has enabled the introduction of new hip resurfacings, and many implant manufacturers have introduced such systems. Early results are encouraging, and complications commonly seen in the 1970s and 1980s, such as early implant loosening and femoral neck fracture, are rare. Background research and better understanding of implant failure suggest that current hip resurfacing technology has developed beyond that of an experimental procedure.     

正确认识微创人工全髋关节置换术和髋关节表面置换术

近年来，人工髋关节外科的发展迅速，模型设计、假体材料、生物力学、部件可调换性、手术器械、手术技术等方面都有了很大进步，手术效果和假体存活率令人鼓舞，其中主要的进步之一就是微创全髋关节置换术的开展。微创全髋关节置换包含软组织的微创和骨的微创，而后者就是指髋关节的表面置换。     

Total hip arthroplasty and hip resurfacing arthroplasty in the very young patient

Severe hip arthritis in an adolescent or very young adult can be a devastating disability that affects all aspects of a patient’s life. Newer treatment strategies in pediatric orthopedic surgery and hip preservation potentially could lessen the impact of this severe disorder in the future. Careful patient selection can lead to excellent outcomes for both THA and/or HRA in young patients. Further study will likely shed more light on whether HRA truly has more improved functional results than THA, and studies with longer follow-up that show definitive revision rates also should affect the future of HRA.     

髋关节表面置换术的进展

随着对髋关节力学认识的加深和材料学的进展,表面置换重新受到重视,因其精确重建股骨近端和髋关节的正常解剖结构,术后具备良好的生物力学和关节稳定性,运动能力的恢复更接近于正常,降低了髋关节二次手术的难度等等优点,成为当今关节外科的最主要进展,具有广阔的临床应用前景。但尚存在如股骨颈骨折、缺血性坏死、金属离子水平升高等特殊而严重的并发症等需要解决的问题,除选择合适的适应症患者,不断改进假体材料和工艺、提高临床技术外,尚需进一步随访观察和验证。     

Complications associated with hip resurfacing arthroplasty

Hip resurfacing arthroplasty is an old orthopedic concept that has undergone a resurgence of interest in the past decade. Because of the rapid increase in the number of procedures being performed, previously recognized complications have begun to recur. This article focuses on complications that are related to the hip resurfacing procedure such as femoral neck fractures, avascular necrosis, raised metal ion levels, and sound initial and durable long-term fixation of an all-metal monoblock cobalt/chrome acetabular component. Dislocation rates after resurfacing and other complications are briefly discussed.     

Complications after metal-on-metal hip resurfacing arthroplasty

This article determines the incidence and cause of the complications commonly associated with metal-on-metal hip resurfacing implants and the proposed methods to prevent these complications. The literature available in PubMed was reviewed. Complication rates after hip resurfacing are low, and the procedure has shown both safety and efficacy in the hands of surgeons trained in specialized centers. Proper surgical technique can further reduce the incidence of femoral neck fracture, component loosening, and abnormal wear of the prosthesis. A more systematic detection of adverse local tissue reactions is needed to provide accurate assessments of their prevalence.