全髋关节置换术治疗中青年强直性脊柱炎髋关节骨性融合的疗效

目的观察人工全髋关节置换术(THA)治疗中青年强直性脊柱炎(AS)髋关节骨性融合的疗效。方法采用THA治疗26例中青年AS髋关节骨性融合患者(31髋)。患者AS导致髋关节病变距行THA时间为2～26(11. 2±0. 8)年。均采用生物型假体。结果 1髋术中发生股骨近端劈裂骨折,予钢丝环扎固定; 1髋术后发生坐骨神经牵拉伤,半年后康复; 1髋髋关节后脱位即时手法复位。患者均获得随访,时间36～123(36. 5±2. 8)个月。随访期间假体位置良好,未出现松动、下沉。术后3个月,1髋发生髋臼侧透亮线,2mm;所有股骨侧未见透亮线; 4髋发生异位骨化。Harris评分术前为12～30(20. 1±1. 8)分,末次随访时为78～92(87. 1±7. 1)分;总被动活动度术前为0°,末次随访时为171°～235°(215. 0°±22. 0°);被动屈曲度术前为0°,末次随访时为70°～102°(85. 8°±9. 3°); Harris评分、总被动活动度、被动屈曲度末次随访时均较术前显著提高(P 0. 01)。结论 THA治疗AS髋关节骨性融合可获得满意的髋关节功能恢复以及优良的假体生存率。     

保留股骨颈全髋置换术治疗强直性脊柱炎

强直性脊柱炎(ankylosing spondylitis,AS)患者中髋关节受累的发病率亦可达25%～50%,而其中50%～90%为双侧受累.随着AS病情发展,髋关节疼痛症状的加剧,髋关节畸形和功能障碍,严重地影响患者的生活质量.人工全髋关节置换术(total hip arthroplasty,THA)可以有效缓解髋关节疼痛症状,重建髋关节生理结构,恢复髋关节的功能,显著地提高了AS患者的生活质量[1].保留股骨颈全长的THA具有保留较多骨储备的优势.我科自1999年12月至2007年5月行THA的AS患者中19例(31髋)保留了股骨颈,现将诊疗效果报告如下.     

全髋关节置换术治疗强直性脊柱炎合并髋关节骨性融合的中期随访研究CSCD

目的:评价全髋关节置换术(THA)治疗合并髋关节骨性融合的强直性脊柱炎(AS)患者的中期随访结果。方法:回顾性分析2003年1月至2020年9月因AS合并单侧或双侧髋关节受累而行THA的431例(627髋)患者的临床资料。根据术前骨盆正位X线片判定是否存在髋关节骨性融合,并将患者分成骨性融合组137例(218髋)和非骨性融合组294例(409髋)。收集并比较两组患者的基线资料,包括人口学资料、疾病相关数据、实验室检查结果及手术相关数据。结果:全部患者获得103(61,146)个月随访。围手术期并发症方面,骨性融合组包括术中假体周围骨折10例、坐骨神经损伤2例、脱位2例及术后关节弹响2例,非骨性融合组包括术中假体周围骨折12例、坐骨神经损伤2例、假体周围感染2例、术后关节弹响3例,两组总的并发症发生率差异无统计学意义(P=0.239)。临床随访结果显示,骨性融合组患者Harris髋关节评分(HHS)从术前33.0(17.5,44.0)分提高至末次随访时的86.0(78.0,94.0)分(P<0.001),但显著低于非骨性融合组(P<0.001)。骨性融合组的巴氏AS疾病活动度指数(BASDAI)和巴氏AS功能指数(BASFI)均显著高于非骨性融合组(P均<0.001);术后穿鞋袜困难程度显著高于非骨性融合组(P=0.035)。结论:AS合并髋关节骨性融合患者进行THA重建股骨近端存在多种并发症风险,总体临床疗效逊于非骨性融合患者,但整体疗效值得肯定。     

人工全髋关节置换在骨性强直髋治疗中的临床及放射学评估

目的:对人工全髋关节置换(THA)在骨性强直髋治疗中的临床及放射学效果进行评估。方法:自2003年1月至2009年8月,20例(30髋)骨性强直的髋关节患者采用THA治疗,其中男12例,女8例;平均年龄36岁。术后临床随访根据Harris评分、患者疼痛缓解满意度、肢体长度差异、髋关节活动范围以及髋关节外展肌力进行评价。X线影像学随访包括对髋臼及股骨柄假体周围骨溶解、假体松动、透光线及异位骨化进行评价。术后平均随访时间为4年。结果:Harris评分由术前的平均(40.75±6.52)分提高至术后平均(86.40±5.42)分;邻近受累关节疼痛完全缓解13例,部分缓解7例;13例外展肌力量恢复满意,跛行症状明显缓解,肢体短缩下降至小于0.5cm;髋关节活动范围较术前显著改善。放射学评估发现2例髋关节周围异位骨化,1例股骨假体周围透光线,无关节假体脱位及翻修的病例。结论:近期随访发现THA在治疗骨性强直的髋关节中可以获得满意的临床疗效,矫正髋关节畸形,恢复髋关节功能,减轻患髋邻近关节的疼痛,改善患者的生活质量。     

强直性脊柱炎股骨近端前倾角和颈干角测量结果

背景：强直性脊柱炎（ankylosing spondylitis,AS）的股骨近端形态学参数,包括前倾角（femoral proximal anteversion angle,FPA）和颈干角（neckshaft angle,NSA）,可能随脊柱-骨盆-髋关节整体结构的变化而发生改变,进而影响全髋关节置换术（total hip arthroplasty,THA）术后的生物力学机制和关节稳定性。目前相关临床研究甚少且不够深入。目的：测量AS股骨近端形态学参数结果,分析其对于THA股骨假体选择的提示意义。方法：选择2010年9月至2011年10月行THA的AS患者30例和健康对照者30例。分别通过双髋关节正位X线片和股骨CT扫描测量FPA和NSA。结果：AS组平均NSA显著高于对照组（138.00°±12.67°vs132.23°±5.88°,P=0.002）,两组FPA无显著性差异（13.41°±10.02°vs11.55°±9.11°,P=0.29）。AS组中融合组平均NSA显著高于非融合组（145.29°±15.27°vs133.46°±8.07°,P〈0.001）,两组FPA无显著性差异（14.99°±11.08°vs12.43°±9.33°,P=0.674）。结论：AS组与对照组相比呈明显髋外翻趋势,但并未表现出FPA增大趋势。AS组中融合组患者髋外翻趋势更加明显,但FPA并未显著增大。个别AS患者FPA过大或股骨近端后倾,可能是AS自身炎症、骨化过程以及胸腰段后凸畸形继发骨盆、髋关节和膝关节代偿变化而综合影响的结果,提示AS髋关节融合的位置和角度具有较大的变异度,需要术者具体分析,选择合理的股骨假体。     

人工全髋关节置换术治疗先天性髋关节脱位72例报告

目的探讨人工全髋关节置换术(THA)治疗先天性髋关节脱位(CHD)的临床疗效。方法回顾性分析2013年1月至2016年6月南京医科大学第一附属医院采用THA治疗的72例CHD患者的临床资料。记录患者切口愈合和并发症发生情况,观察假体初始固定位置、假体位移和股骨-假体界面稳定性,计算假体髓腔填充率,比较患者手术前后Harris髋关节功能评分及肢体短缩长度变化。结果术后切口均Ⅰ期愈合,无神经损伤、下肢静脉血栓形成及髋关节再脱位并发症发生。67例患者股骨假体初始位置处于中立位固定、2例轻度外翻、2例外翻固定、1例内翻固定。患者随访时间24～28个月,平均随访时间(26.6±1.5)个月。末次随访时假体髓腔股骨柄填充率(80.5±2.2)%,股骨柄远端、中部、近端填充率分别为(84.9±2.9)%、(79.8±2.9)%和(88.7±3.1)%;股骨-假体界面稳定性为100%,髋臼-假体界面稳定性94%;Harris髋关节功能评分、肢体短缩长度较术前明显改善(P 0.05)。结论 THA治疗CHD具有股骨假体初始位置固定牢靠、假体填充率高、股骨-假体界面稳定性优良、髋关节功能恢复良好、肢体短缩改善明显等优势,疗效满意。     

一期双侧Tri-lock柄THA治疗强直性脊柱炎髋关节强直

[目的]探讨一期Tri-Lock骨保留型股骨柄假体全髋关节置换术(total hip arthroplasty, THA)治疗强直性脊柱炎(ankylosing spondylitis, AS)累及双侧髋关节骨性强直的临床疗效。[方法]本院关节外科于2010年12～2018年12月治疗一期采用Tri-lock柄行THA的12例(24髋)强直性脊柱炎累及双侧髋关节骨性强直患者,其中男9例,女3例;年龄19～37岁,平均(28.32±6.43)岁。病程6～21年,平均(12.30±3.50)年。术中股骨颈均采用二次截骨,术后骨盆正位及双侧髋关节侧位X线片,评价人工髋关节假体位置,Engh标准评价骨-假体界面稳定性,Harris评分标准评价髋关节功能。[结果]均获随访13个月～7年,平均(5.60±2.20)年。术后12例(24髋) Harris评分(91.50±3.10)分,与术前相比,差异有统计学意义(P0.05)。术后1例发生坐骨神经麻痹,经屈髋屈膝位对症处理后治愈,其余患者均无骨折、血管神经损伤、髋关节脱位、感染、假体松动、深静脉血栓、肺部感染等并发症发生。[结论]一期Tri-Lock骨保留型股骨柄假体THA治疗强直性脊柱炎累及双侧髋关节强直,可有效改善双侧髋关节活动度,重建髋关节功能,提高患者生活质量。     

生物型短柄与标准柄对全髋关节置换术股骨偏距影响

[目的]比较生物型短柄和标准柄对全髋关节置换术(total hip arthroplasty,THA)股骨偏距的影响差异.[方法]回顾性分析2018年1月～2018年12月本院收治且行单侧THA的患者,共100例患者纳入本研究.其中50例采用短柄假体置换,50例采用标准柄假体置换,比较两组股骨偏距、颈干角和下肢长度差异...     

全髋关节置换术治疗强直性脊柱炎累及髋关节的疗效观察

目的总结全髋关节置换术(total hip arthroplasty,THA)治疗强直性脊柱炎(ankylosing spondylitis,AS)累及髋关节的中远期疗效,并对影响疗效的因素进行探讨。方法 1999年3月—2011年5月采用THA治疗32例(42髋)AS累及髋关节患者。男26例,女6例;年龄20~78岁,平均39岁。病程2~41年,中位病程10年。假体摩擦界面采用金属-聚乙烯者19髋,陶瓷-陶瓷者23髋;股骨头假体采用36 mm直径者15髋,28 mm直径者27髋;假体均采用生物学固定。手术前后测量并记录患者髋关节总活动度(屈-伸、内收-外展、内旋-外旋活动度总和),髋关节功能采用Harris评分、疼痛程度采用疼痛视觉模拟评分(VAS)评价。根据X线片,髋臼侧和股骨侧假体分别采用De Lee分区和Gruen分区描述;异位骨化程度采用Brooker标准。结果术后患者切口均Ⅰ期愈合,无麻醉意外、感染及神经、血管损伤等并发症。术后29例(39髋)获随访,随访时间5~17年,平均9年。术后股骨头假体28 mm直径组24髋中发生髋关节前脱位2例(2髋),36 mm直径组15髋无脱位发生。末次随访时,所有患者VAS评分、Harris评分及髋关节总活动度均较术前显著改善(P0.05)。其中术前病程越短,术后Harris评分越高、髋关节总活动度越大(P0.05);股骨头假体直径越大,术后髋关节总活动度越大(P0.05)。末次随访时臼杯和股骨柄假体均固定良好。采用金属-聚乙烯假体的18髋中,臼杯周围显示有广泛性骨溶解者9髋(50%),但假体尚无松动;采用陶瓷-陶瓷假体的21髋中无任何骨溶解和假体松动征象。7髋发生异位骨化,其中BrookerⅠ级5髋,Ⅱ级2髋。结论 THA是治疗AS累及髋关节的有效手段;术前病程短,并采用大直径股骨头陶瓷-陶瓷假体行THA者,术后疗效更好。     

全髋关节置换术治疗成人髋关节发育不良继发骨关节炎五年以上随访研究

目的 评价全髋关节置换术(total hip arthroplasty,THA)在成人髋关节发育不良(develop-mental dysplasia of the hip,DDH)继发骨关节炎患者中的疗效,回顾性分析该类患者THA术后5年以上的临床疗效及其影响因素.方法 对2000年2月至2002年7月在我院采用THA治疗DDH继发骨关节炎的患者55例(69髋)进行术后随访.临床评估以Harris评分为标准.影像学评估根据随访骨盆平片及患髋正、侧位X线片,观察髋臼、股骨假体位置及其周围骨质变化,测量内衬磨损率.假体生存率采用Kaplan-Meier方法进行分析,以任何原因的臼杯、股骨柄翻修或影像学假体明显松动为随访终点.结果 截至随访终点,共45例(57)髋获得5年以上随访,平均随访时间69个月,随访率为81.8%.Harris评分由术前的(46.19±18.01)分提高至末次随访时的(91.78±3.52)分,尚无假体翻修病例.聚乙烯内衬平均磨损率为(0.27±0.14)mm/年.5髋髋臼侧发生骨溶解,8髋股骨侧近端发生骨溶解.Kaplan-Meier分析假体总生存率为1.0(95%可信区间,0.98～1.00).结论 THA治疗DDH继发骨关节炎5年以上随访的影像学表现及临床效果尚可,但存在较高的聚乙烯磨损率及骨溶解发生率,对于年轻、活动量大的DDH患者,THA手术时应选择新型耐摩擦界面假体.DDH患者的定期随访尤为重要,可甲期发现骨溶解,及时给予相应的治疗.     

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。     

Total Hip Arthroplasty Using a Cylindrical Cementless Stem in Patients With a Small Physique

We performed total hip arthroplasty using an anatomic medullary locking cementless stem for small-physique patients from 1988 to 1995. We conducted a retrospective study of 50 joints in 44 cases, including 40 developmentally dysplastic hips followed for 12 to 20 years (average, 15.1 years). Average height and body weight were 152 cm and 56 kg (5.0 ft and 124 lb), respectively, with an average body mass index of 24.2. Twelve joints (24%) were revised for acetabular-sided failures. Forty-eight stems (96%) showed bone ingrowth fixation, and there were no unstable stems. The simple cylindrical shape of the distal portion of the AML stem was less affected by deformity of the proximal femur of developmental dysplasia of the hip in patients with a small physique, and both clinically and radiologically good results were confirmed at long-term follow-up.     

3D打印技术在成年发育性髋关节发育不良患者股骨柄匹配度测量中的应用

目的利用3D打印技术为成年发育性髋关节发育不良(DDH)患者股骨柄的选择提供参考。方法收集23例成年DDH患者(29髋),利用3D打印机制作全股骨模型,在同一模型中分别置入矩形柄和锥形柄髓腔锉,进行CT检查,比较两种形状股骨柄在股骨髓腔中4个位置处的匹配度。结果按照髓腔开口指数(CFI)分型,香槟型8髋,正常型11髋,烟囱型10髋。通过匹配度比较,香槟型更适合锥形柄(P<0.01),正常型在两种柄的匹配度上差异无统计学意义(P>0.05),而烟囱型与矩形柄更匹配(P<0.01)。结论通过3D打印技术,可以1∶1还原DDH患者股骨近端形态,对同一模型上模拟安装两种形状的股骨柄进行匹配度的比较,可以为人工全髋关节置换术中股骨柄的选择提供参考。     

Second- and third-generation Omniflex modular femoral stem: results 3 to 8 years after surgery

Primary cementless total hip arthroplasty (THA) using the Omniflex modular femoral stem was conducted on 73 hips in 70 patients. The arc deposition (AD)-type stem was used in 26 hips, and the hydroxyapatite (HA)-type stem was used in 47 hips. The mean follow-up period of patients in the AD group was 78 (range, 61-96) months and that of patients in the HA group was 52 (range, 36-61) months. Clinically, improvement in the Harris hip score occurred in all cases. Thigh pain was reported in 3 (11.5%) AD hips and in 1 (2.1%) HA hip. Radiologically, bone ingrowth fixation was seen in 88.5% of the AD group and in 97.9% of the HA group. No subtrochanteric stress shielding, stem migration of > 2 mm, or revision THA occurred. The second- and third- generation Omniflex stems are useful cementless devices resulting in favorable initial biologic fixation and little bone atrophy at mid-term follow-up.     

Long-Term Outcomes of Revision Total Hip Arthroplasty Using a Tapered and Fluted Modular Stem: A Mean Follow-Up of 16 Years

BackgroundTapered modular stems are increasingly used in revision total hip arthroplasty (THA) with deficient femoral bone stock. This study aimed to report the long-term outcomes of revision THA using a tapered and fluted modular stem.MethodsBetween December 1998 and February 2006, 113 revision THAs (110 patients) were performed with a tapered and fluted modular stem at a single institution. Hip radiographs were used to identify stem subsidence, stability, and femoral radiolucency. Final outcomes were assessed in 72 hips (70 patients), with a minimum follow-up of 10 years.ResultsThe mean follow-up duration was 16 years (range, 10-23). At the final evaluation, the Harris Hip Score improved from a mean of 41 points (range, 10-72) preoperatively to 83 points (range, 56-100) (P < .001). Six femoral re-revisions were performed for the following reasons: 1 aseptic loosening, 2 stem fractures, and 3 infections. One stem fracture occurred at the modular junction after 14 years, and the other at a more distal location after 15 years. Stem subsidence was >5 mm in 6 hips (9.1%), but secondary stability was achieved in all stems. Osseointegration was observed in 63 (95.5%) hips. Stem survivorship was 91.1% with an end point of any re-revision and 94.6% for aseptic re-revision.ConclusionA tapered and fluted modular stem demonstrated excellent implant survivorship with reliable bony fixation at a mean follow-up of 16 years. This type of stem can be a durable option for revision THA in patients who have femoral defects.     

Total hip arthroplasty using cementless grit-blasted femoral component: a minimum 10-year follow-up study

The grit-blasted cementless Spotorno (CLS) stem, which has excellent survival rates up to 10 years, is widely used in total hip arthroplasty (THA). We investigated the survivorships of CLS stems in THA at a minimum follow-up of 10 years and sought to identify factors that influence outcomes. A total of 227 hips of 191 patients who underwent cementless THA with a CLS stem were retrospectively reviewed at a mean follow-up of 12.3 years. All patients were evaluated clinically and radiographically according to implant type and surgery-related and patient-related factors. Survivorship was 97.2% when femoral revision for any reason was defined as the end point. Femoral revisions were performed in 3 hips because of periprosthetic fractures. Survivorship for all hips, using revision for any reason as the end point, was 92.6%. Two metal-on-metal THAs were revised because of aseptic loosening or osteolysis around the cup. No significant differences were evident for type of stem, type of bearing surface, stem alignment, or patient-related factors. However, a canal fill index of 80% or less was found to affect cortical remodeling, subsidence, and a change in stem position of 5° or more, which indicates that care must be taken not to undersize stems. In addition, in view of the revisions performed, bearing surfaces appear to importantly influence THA survivorship.     

Reduced Incidence of Intraoperative Femur Fracture With a Second-Generation Tapered Wedge Stem

Background

Intraoperative fractures during total hip arthroplasty (THA) are more common when using cementless stems. The purpose of this study was to investigate the impact of a new shorter second-generation cementless, tapered wedge stem with improved proximal femoral fit in reducing the incidence of intraoperative fracture.

高位脱位髋臼发育不良中不同亚型的股骨形态差异

目的明确高位脱位髋臼发育不良中C1型与C2型股骨近端的形态有无差别,以及C1型与C2型股骨脱位高度是否相同。方法回顾性分析54例高位脱位近端股骨患者的临床资料,C1型28髋,C2型26髋。在髋关节正位、侧位平片上测量股骨干及髓腔的内外径,同时测量股骨头高度、股骨脱位高度、大转子高度。由两名独立研究者对测量的可重复性进行试验,发现测量者内和测量者间的一致性很好。结果与C1型股骨相比,C2型股骨近端股骨窄,髓腔指数更小（2.7±0.6）,更像烟囱型。C2型股骨脱位比C1型高18 mm。结论两种亚型股骨形态的差异在手术处理时需要采用不同的方式和不同形态的假体来重建近端股骨。     

Preoperative Planning and Operative Techniques of the Shorter Tapered Stem Compared to the Metaphyseal Fit Stem in Cementless Total Hip Arthroplasty

Background

In order to prevent postoperative dislocation due to prosthetic impingement as a result of total hip arthroplasty (THA), the combined anteversion (CA) theory, which combines the anteversion of the femoral stem and the acetabular socket, has been revised in recent years. Particularly, it is necessary to keep CA within the target zone.

Cementless double-tapered total hip arthroplasty in patients 75 years of age and older

Concerns exist with cementless total hip arthroplasty (THA) femoral fixation in the elderly patient population. This study reviews the outcomes of a tapered cementless femoral component in elderly patients 75 years of age and older. Forty-seven patients (49 hips) older than 74 years of age (average age, 79 years) underwent primary cementless THA with a double-tapered stem between 1996 and 2000. Radiographs and clinical data were reviewed. At a mean follow-up of 5 years, the mean postoperative Harris Hip Score was 84, with 87% having no or minimal pain; none had severe thigh pain. Two cases of stem subsidence and no progressive radiolucencies were seen. One well-fixed stem was revised for unexplained pain (2%). Survival with aseptic loosening as an end-point was 100%. Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA.