类风湿性关节炎继发髋臼内陷的髋关节置换

背景：类风湿性关节炎导致的髋臼内陷，髋臼运动中心重建和髋关节功能重建是人工全髋置换的两大技术难点。目的：探讨类风湿性关节炎继发髋臼内陷时行的髋关节置换的效果。方法：纳入治类风湿性关节炎累及髋关节造成髋臼内陷的患者16例（22髋）行全髋关节置换，其中男5例8髋，女11例14髋。所有患者置换过程中均行不同程度植骨，置换后随访28—94个月，平均50个月，行髋关节×射线进行影像学评估，关节活动度、Harris评分进行临床疗效评估。结果与结论：至末次随访，所有患者获得影像学上假体良好稳定，假体周围无明显透亮线，移植骨稳定，Harris评分由置换前42．4±8．6，上升为87．5±5．6，关节活动度中屈曲由置换前（45．2±5．5）°，提高为（95．6±5．8）°，外展由（15．2±8．5）°，提高至（32．6±6．6）°。说明类风湿性关节炎继发髋臼内陷，进行全髋关节置换时，根据骨缺损情况结合自体骨移植，能有效恢复髋关节中心，重建髋关节功能。

Total hip arthroplasty for the treatment of acetabular protrusion secondary to rheumatoid arthritis

BACKGROUND： The rheumatoid arthritis can induce acetabular protrusion, and the reconstruction of the movement center and hip function are the two difficulties for total hip arthroplasty.OBJECTIVE： To discuss the clinical efficacy of total hip arthroplasty for the treatment of rheumatoid arthritis induced acetabular protrusion. METHODS： Twenty-two hips in 16 patients with rheumatoid arthritis induced acetabular protrusion were involved, including five male patients with 8 hips and 11 female patients with 14 hips. They all received bone graft during total hip arthroplasty. All the patients were followed-up for 28- 94 months, 50 months in average, and then imaging assessment was performed with hip X-ray films. The range of motion and the Harris score were used to evaluate the clinical efficacy. RESULTS AND CONCLUSION： Up to the final follow-up, all patients got prosthesis stability and stable bone graft, and there was no obvious radiolucent line around the prosthesis. The Harris score was increased from （42.4±8.6） before replacement to （87.5±5.6） after replacement, and the inflection angle of range of motion was increased from （45.2±5.5）° to （95.6±5.8）°, the abduction angle increased from （15.2±8.5）°to （32.6±6.6）°. Total hip arthroplasty combined with autogenous bone graft for the treatment rheumatoid arthritis induced acetabular protrusion can effectively restore the hip center and reconstruct the hip function. Key Words： bone and joint implants; clinical practice of bone and joint; rheumatoid arthritis; total hip arthroplasty; acetabular protrusion; autogenous bone graft; hip prosthesis; biological prosthesis; radiographic evaluations; range of motion; Harris score; biological fixation; stability; Sotello-Garza classification; Charnley classification