先天性和陈旧性髋关节脱位的全髋置换术

目的 探讨先天性髋关节脱位和陈旧性髋关节脱位患者人工全髋关节置换术的适应证和髋臼假体安放位置的选择.方法 先天性髋关节脱位10例(13髋)和陈旧性髋关节脱位6例(6髋),均采用改良Gibson入路,髋臼假体安放在髋关节假臼位置,关闭切口时尽可能修复髋关节周围软组织结构.结果 16例均经1～3年随访,疗效评定参照Charnley标准,关节功能优10例(11髋),良好3例(5髋),可3例(3髋).结论 先天性髋关节脱位和陈旧性髋关节脱位人工全髋关节置换术的髋臼假体位置的选择不能一概而论,应根据移位的远近、骨质条件和重建软组织平衡的难易程度而定.     

成人严重先天性髋脱位的人工全髋关节置换术

[目的]探讨成人严重先天性髋关节脱位行人工全髋关节置换术的方法及治疗效果。[方法]13例CroweⅣ级的患者行人工全髋关节置换手术，术前进行骨牵引治疗2周，术中在松解延长的基础上，重建髋关节旋转中心及髋关节外展功能。术后评估肢体延长长度及髋关节功能。[结果]术后平均随访18个月，髋关节Harris评分平均90分，患肢长度平均延长3．1cm，有1例出现坐骨神经牵拉症状，短期未出现假体失败现象。[结论]通过松解延长、重建关节功能、选择合适的假体，并注重对神经血管的保护，成人严重先天性髋脱位可以通过人工全髋关节置换术获得满意的治疗效果。     

结构性植骨全髋关节置换在成人高位先天性髋关节脱位中的应用

[目的]探讨结构性植骨全髋关节置换治疗成人高位先天性髋关节脱位的临床疗效。[方法]2003年8月～2006年10月,采用结构性植骨全髋置换治疗成人高位先髋脱位22例,29髋。男10例,女12例。左13例,右16例,年龄平均34.6岁(23～42岁)。临床症状主要为患髋疼痛、不稳定和跛行。术前Harris评分平均为46.8分,双下肢长度差异平均为3.8cm,股骨头脱位高度平均为3.9cm,髋关节平均活动度:屈曲66.5°,外展23.8°,外旋20.4°,内旋5.3°。术中臼杯均安装于真臼处,自体股骨头结构性植骨使臼杯完全覆盖,充分软组织松解后髋关节复位。髋臼侧选用骨水泥假体18髋、小髋臼生物型假体5髋和普通生物型髋臼6髋;股骨侧选用生物型假体10髋、普通骨水泥假体13髋、窄直柄水泥假体柄4髋和长柄骨水泥假体柄2髋。观察手术时间、出血量、关节活动度、双下肢长度差异、并发症等并进行Harris关节功能评分。[结果]本组平均手术时间95min(70～135min),出血400ml(300～650ml);伤口均一期愈合,无1例感染;术后1周X线片示假体位置良好,人工髋臼外展角平均为48.6°,前倾角平均13.2°。本组22例均获随访,随访时间平均17.6个月(10～47个月),Harris评分平均89.2分(72～93分);髋关节平均活动度:屈曲115.3°,外展44.6°,外旋49.5°,内旋26.8°。双下肢长度差异平均1.2cm,2例术后股神经麻痹,术后4个月内恢复。随访期间未见明显植骨块吸收、假体松动和脱位。[结论]结构性植骨全髋关节置换是治疗成人高位先天性髋关节脱位的一种有效方法,很大程度地改善了患者的症状、功能和外形。结构性植骨可提供良好的髋臼覆盖,恢复髋关节旋转中心高度并可保留骨盆骨量。脱位高度小于4cm经软组织充分松解后能下拉复位,不会造成股神经及坐骨神经永久性麻痹。     

Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae

We retrospectively evaluated the postoperative results of total hip arthroplasty (THA) in patients presenting with Crowe group IV dislocated hips. Overall, results were compared with regard to the type of osteotomy performed (Z or oblique) to define the correct indications for surgical technique and choice of prosthetic implant. Thirty-three subtrochanteric shortening and derotational osteotomies in primary THA were performed in 26 patients secondary to congenital hip dislocation. A Z osteotomy was performed in 14 cases and an oblique osteotomy in 19. The surgical approach was direct lateral, and surgery was aimed at restoring the anatomic hip center. Femoral and acetabular fixation was uncemented. The most used stem was the S-ROM (DePuy, Leeds, United Kingdom), and the couplings used were ceramic-ceramic (7 cases), ceramic-polyethylene (3 cases), metal-polyethylene (15 cases), and metal-metal (3 cases). Mean follow-up was 88±45 months. According to the Merle D'Aubigné score, the overall clinical results were good in 23 cases, satisfactory in 6, and fair in 4. Union of the osteotomy occurred in 97% of cases, and the mean time required for osteotomy union was 6±2 months without significant differences between Z and oblique osteotomies. At last follow-up, there was loosening of 1 cup and 1 stem, and revision was necessary. Twelve percent of patients experienced postoperative dislocation and 9% developed neuropraxia of the femoral nerve. The clinical and radiological results were similar in both groups, with a high rate of pain relief, an improvement in limb-length discrepancy, and reduced limping, leading to a smaller or no insole. Currently, the more complex Z osteotomy has been abandoned, because a modular stem prosthesis with metaphyseal sleeve allows the oblique osteotomy to be used with an easier and shorter surgical procedure.     

Total hip arthroplasty for developmental hip dysplasia

We reviewed 38 hip replacements in 33 female patients (mean age 55.3 years) with developmental hip dysplasia. One patient had died and the remaining 32 patients (36 hips) had a mean follow-up of 12.2 years (range 8–19 years). All hips were replaced using the Müller cemented implant, and in 32 hips bulk femoral head autograft was used. In 33 hips the socket was reconstructed at the level of the true acetabulum. Complications included one intra-operative femoral fracture and two early dislocations. Correction of leg length discrepancy was possible in 30 patients. The post-operative mean modified Merle d’Aubigne and Postel scores for pain, movement and walking were 5.9, 5, and 5.3 respectively. One cup was revised due to aseptic loosening at ten years. All grafts united, but minor graft resorption was noticed in 24 hips, moderate in 2 hips and major in 1 hip.

---

Résumé Nous avons examiné 38 remplacements prothétiques de la hanche chez 33 femmes (age moyen 55,3 ans) avec une dysplasie de la hanche. Une patiente était décédée et les 32 autres (36 hanches) avaient un suivi moyen de 12,2 ans ( 8 à 19). Toutes les hanches ont eu un implant type Müller cimenté et pour 32 une autogreffe massive de tête fémorale a été utilisé. Pour 33 hanches la cavité a été reconstruite au niveau du paléo-cotyle. Les complications comprenaient une fracture fémorale opératoire et deux luxations précoces. La correction de l’inégalité de longueur des membres inférieurs était obtenue chez 30 malades. Le score postopératoire modifié de Merle d’Aubigné et Postel pour la douleur, la mobilité et la marche étaient en moyenne de 5,9, 5 et 5,3 respectivement. Une cupule a été révisée pour un descellement aseptique à 10 ans. Toutes les greffes ont consolidé, mais une résorption mineure de la greffe a été remarquée dans 24 hanches, une résorption modéré dans deux hanches et majeure dans une.

     

Total hip arthroplasty for osteonecrosis

The success of Charnley cemented total hip arthroplasty for osteonecrosis of the femoral head was assessed using survival analysis. Eighty-seven total hip arthroplasties were followed up for an average of 5.7 years (range, 1.4-13.0 years). There were 59 women and 28 men. The average age was 60 years (range, 30-84 years). Using Charnley hip scores, all patients showed significant progress. The survival analysis showed that using femoral loosening, revision, and pain scores less than 5 as end points, survival was 0.61, 0.94, and 0.81, respectively. With revision as an end point, there were no differences between patients in groups less than 50 and greater than or equal to 50 years of age, weighing less than 185 and greater than =185 lb, and men versus women. There was an 11.5% overall revision rate. Charnley cemented total hip arthroplasty is a viable alternative for patients with painful osteonecrosis.     

Total hip arthroplasty in Paget's disease of the hip.

For thirty-two patients with Paget's disease of the pelvis, mechanical disruption of the hip joint caused sufficient pain and disability to require total hip-replacement arthroplasty. Three of the patients had had fractures of the femoral neck. No unusual complications were encountered and the results were excellent.     

Total hip arthroplasty for arthrodesed hips

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.     

Total hip arthroplasty following Girdlestone arthroplasty

Background

Complications associated with re-implantation of total hip arthroplasty (THA) after resection arthroplasty for the treatment of primary septic hip arthritis or infected THA and bipolar hemiarthroplasty (BHA) are not well-documented. Furthermore, no comparison has been made between septic arthritis (SA) and infected THA and BHA. We divided subjects into two groups for evaluation: a SA group and an infected THA or BHA group.

全髋关节置换术治疗髋臼内陷症

[目的]探讨全髋关节置换术治疗伴有疼痛的髋臼内陷症（Otto’s disease）的疗效。[方法]15例患者接受了THA,其中男性7例,女性8例;平均年龄65岁（56～70岁）。5例（33.3%）为Ⅰ度内陷,10例（66.7%）为Ⅱ度内陷。所有患者的髋臼侧均接受了自体或异体颗粒骨移植,并应用多孔生物型髋臼假体。手术前后记录髋关节Harris评分,拍摄标准X线片。[结果]平均随访时间为3年（1～4年）。Harris术前平均为45分（39～60分）,术后平均为85分（70～100分）。放射学表现,术前平均股骨头内陷8.8 mm（6～18 mm）,术后人工股骨头平均距Kohler’s线外移10 mm（6～13 mm）。所有患者髋臼假体没有失败及髋臼侧移植骨吸收现象。术后1年经拍片证实自体或异体移植骨均与宿主髋臼骨愈合在一起。[结论]应用自体股骨头骨或异体颗粒骨移植填充髋臼结合多孔生物型髋臼假体,治疗Otto’s病,可获得较好的疗效,移植骨可与宿主骨很好地结合在一起。     

Total hip arthroplasty for tuberculous coxarthrosis

Forty-four total hip prostheses were implanted in thirty-eight patients who had tuberculous arthritis of the hip. The interval between active disease and total hip arthroplasty ranged from three months to forty-five years. The length of follow-up averaged 45.6 months (range, twenty-four to eighty-five months). Cultures of material and specimens of tissue that were taken intraoperatively were positive in four hips. The mean functional rating of the hip was 62 points preoperatively and 85 points at final follow-up. Thirty-one patients had a good result; one had to have a revision because of loosening of a component. Six patients had reactivation of the disease that was controlled satisfactorily by chemotherapy alone or in combination with débridement of sinus tracts without removal of the prosthesis. There was a major difference in the percentage of recurrences in patients who had inactive disease for less than ten years (six of fifteen patients) compared with those who had inactive disease for more than ten years (no patients). Total hip arthroplasty appears to be a safe procedure for patients who have quiescent tuberculosis as well as for patients who have active tuberculosis of the hip when there is no gross evidence of active infection.     

Total hip replacement arthroplasty

Summary A prospective study of 62 total hip replacements performed between February 1970 and December 1972 in 50 patients was carried out. The results were assessed according to the Asaf Harofe Hip Evaluation System. There were excellent and good results in 89% of hips. Failures occured in 11% and were due to individual cases of loosening of the femoral component, loosening of the acetabular cup, painful hip in a man with angina pectoris, sciatic causalgia and limited hip motion. In 22% of patients thrombo-embolic episodes were diagnosed. No deaths, deep infections or dislocations occured.

---

Zusammenfassung Es wurde eine Nachuntersuchungsstudie über 62 Hüfttotalendoprothesen, die zwischen Februar 1970 und Dezember 1972 bei 50 Patienten implantiert worden waren, durchgeführt. Bei den verwendeten Endoprothesentypen handelt es sich um 44 Endoprothesen vom Typ Charnley, um 11 vom Typ Müller und um 7 des Typs McKee-Farrar. Die Ergebnisse wurden nach dem Asaf Harofe-Hüftbewertungssystem ausgewertet. Dabei ergaben sich bei 89% der Endoprothesen hervorragende und gute Ergebnisse. Schlechte Ergebnisse lagen bei 11% der implantierten Prothesen vor und waren auf einzelne Fälle von Stiellockerungen, Pfannenlockerungen, Schmerzen im Hüftbereich, Ischiasbeschwerden und eingeschränkte Hüftbeweglichkeit verteilt. Bei 22% der Patienten liefen thrombo-embolische Prozesse ab. Todesfälle, tiefe Infektionen oder Luxationen traten nicht auf.

     

Total hip arthroplasty in Gaucher's disease. Long-term prognosis

Avascular necrosis of the femoral head is a cause of morbidity in patients with Gaucher's disease. Total hip arthroplasty (THA) is recommended, but there is controversy about the long-term value of this procedure. In eight patients treated with 15 THAs, 11 (73%) have remained fully mobile and asymptomatic up to 14 years following surgery. These long-term follow-up observations are evidence in favor of THA for treatment of hip joint problems associated with Gaucher's disease.     

全髋关节置换治疗髋臼发育不良型骨关节炎

目的探讨髋臼发育不良型骨关节炎行人工全髋置换治疗效果。方法对10例（16髋）因髋臼发育不良所引起的严重骨关节炎患者行人工全髋关节置换术。结果随访时间4～68个月,采用Mereled’Aubigne评分标准：优5例,良4例,中1例。结论髋臼发育不良型骨性关节炎行人工全髋置换术可获得好的效果。     

Total hip arthroplasty for active tuberculosis of the hip

Total hip arthroplasty (THA) has been used as a successful form of treatment in patients with long-standing tuberculosis, but it is unclear whether THA should be performed in patients with current infection. We performed THA in six patients with advanced active tuberculosis of the hip from 2002 to 2006. Tuberculosis was confirmed in all cases by histological examination. All patients were treated with antituberculous medications for at least two weeks followed by thorough debridement and THA. Antituberculous medications were administered postoperatively for at least 12 months. The duration of postoperative follow-up was an average of 49 months. No reactivation of the infection was detected in our series. Using the Harris hip score system, five of the patients were classified as excellent and one as good. THA in advanced active tuberculosis of the hip is a safe procedure providing symptomatic relief and functional improvement. Thorough debridement of infected tissues and postoperative antituberculous therapy are the keys to lowering the potential risk of reactivation of tuberculosis.     

色素沉着绒毛结节性滑膜炎行全髋关节置换术治疗的临床评估

目的回顾性研究全髋关节置换术结合滑膜切除治疗晚期髋关节色素沉着绒毛结节性滑膜炎(PVNS)的临床效果。方法对2000年10月至2010年6月间行髋关节切开滑膜清理加人工髋关节置换术治疗的13例晚期髋关节PVNS感染性患者进行回顾性研究,其中8例为局限型,5例为弥漫型,平均年龄33.7岁(21～65岁)。患者术前活动受限症状明显,术前检查提示关节面破坏,关节间隙狭窄,严重的伴有股骨头变形。术中采用关节切开滑膜广泛清理人工髋关节置换。随访分析患者功能恢复情况,比较术前、术后Harris评分及复发情况。结果 10例患者平均术后随访5.6年(0.5～10.3年),未出现复发,假体稳定,Harris评分从术前的47.6分提高到90.8分,能进行日常活动。3例出现复发,其中1例再次行切开清理术,术后良好;1例目前暂时行放射治疗;1例因复发面积广泛压迫下肢血液循环,减容手术无效最终行髋关节离断术。结论全髋关节置换结合增生滑膜切除是治疗局限型PVNS伴有骨质破坏的合适手术方式,能极大改善临床症状,复发率较低。对于弥漫型的治疗,复发率较高,仍待观察。     

Total hip arthroplasty for tuberculous coxitis.

We report a case of tuberculous arthritis of the hip in a 22 year old male patient, treated with arthrotomy and antituberculous antibiotic therapy for 9 months; the joint deteriorated and 2 years later he underwent uncemented total hip arthroplasty. He received antibiotic therapy for 3 months preoperatively and for 6 months postoperatively. At 5 year follow-up there was no evidence of recurrent infection.

---

Résumé. Nous présentons un cas d′un homme de 22 ans, avec une arthrite tuberculeuse, que nous avons traité en faisant une arthrotomie de nettoyage, suivie de traitement anti-tuberculeux pendant 9 mois. Dans les 2 ans suivants il sést développé une sévère destruction de l′articulation avec douleur et limitation des mouvements. Alors, nous avons réalisé une arthroplastie totale de la hanche sans ciment, avec traitement antibiotique depuis 3 mois avant, et jusqu′a 6 mois aprés la chirurgie. Actuellement, le patient n′a pas de symptomes et il n′y a pas de signes d′infection, 5 années après la chirurgie.

---

---

Accepted: 7 October 1999