股骨髓腔狭窄患者生物柄全髋关节置换

背景：亚洲人体型较小,股骨通常较短且髓腔狭窄,进行人工髋关节置换时常会遇到插入困难,目前尚无有关股骨髓腔狭窄患者进行人工关节置换的相关报道。目的：探讨股骨髓腔狭窄患者生物柄假体全髋关节置换的固定特点与临床疗效。方法：2005年5月至2009年8月,采用锥形生物柄进行全髋关节置换22例23髋,男2例2髋,女20例21髋;年龄19～56岁,平均37.6岁。股骨髓腔峡部直径7.5～8.2mm,平均7.8mm。手术采用生物型全髋关节置换假体,其中三锥度生物型股骨直柄18例,二锥度生物型股骨直柄5例。术后第1、3、6个月及1年门诊随访,以后每年随访1次,随访时采用Harris髋关节评分评估髋关节功能,X线片观察假体压配和生物学固定效果。结果：全部病例随访28～72个月,平均38.5个月。1例22mm直径股骨头术后第3天侧卧拍片摆动体位时发生股骨头前脱位,经手法复位后回纳。Harris髋关节评分由术前（46.2±6.2）分改善至术后半年（90.2±5.1）分,末次随访仍维持在（92.1±3.2）分。23髋术后均立即实现股骨柄的压配。正侧位X线片示股骨柄的髓内充填分别达94%～98%,平均96.5%和87%～94%,平均91.2%。术后3个月的X线片示均获得广泛性骨长入。结论：股骨髓腔狭窄患者适当扩髓可获得良好的临床效果,周密而严谨的术前计划可准确地预测出假体型号、位置,并能有效缩短手术时间,减少术后并发症。

Outcomes of total hip arthroplasty in patients with narrow medullary cavity of femur

Background:The physique is small in Asian.Total hip arthroplasty(THA) often meets the great problem in planted procedure for the patients in narrow medullary cavity of femur.Objective:The purpose of the study is to evaluate the clinical outcome of THA for the patients with narrow medullary cavity of femur.Methods:From May 2005 to August 2009,23 patients(23 hips) underwent THA with conical biological handle.There were 20 females(21 hips) and 2 males(2 hips) with an average age of 37.6 years(range,19-56 years).The mean diameter of femoral isthmus was 7.8 mm(range,7.5-8.2 mm).Double-tapered medullary stem was implanted in 5 patients and triquetrous-tapered in 18 patients.The patients were followed up at 1,3,and 6 months after surgery and at the last follow up.Hip joint function was assessed by Harris hip scoring.Prosthesis stabilization was observed by X-ray examination.Results:The mean duration of follow-up in all the patients was 38.5 months(range,28-72 months).Harris hip scores were 46.2±6.2,90.2±5.1,and 92.1±3.2 before and after surgery,and at the last follow-up,respectively.The anteroposterior and lateral X-ray films showed bone ingrowths fixation in all 23 hips at 3 months after surgery and the mean medullary filling rates were 96.5%(94%-98%) and 91.2%(87%-94%).Conclusions:The suitable enlargement of narrow medullary cavity of femur can achieve better outcomes in THA.Detailed preoperative plan can offer support in optimal prosthesis selection and reduce complications.