非骨水泥型全髋关节置换术治疗酒精性股骨头坏死

[目的]研究非骨水泥型全髋关节置换术治疗酒精性股骨头坏死的中期疗效.[方法]1997年3月～2002年6月,采用非骨水泥型全髋关节置换术治疗酒精性股骨头坏死41例(47髋),进行至少5年的随访、中期临床评估和影像学评估.临床评估以Harris评分为标准.影像学根据骨盆正位和髋关节侧位X线片,观察髋臼、股骨假体的位置以及周围骨质的改变.假体的生存率采用Kaplan-Meier分析,分别以股骨、髋臼假体的无菌性松动和任何原因所致的翻修为终点.[结果]得到至少5年随访的41例(47髋),术前Harris评分为42.4±6.4(24～49)分,最后1次随访评分为91.8±4.4(74～100)分.至最后1次随访时无1例翻修或表现为影像学无菌性松动,2髋出现骨盆局灶性骨溶解,6髋出现股骨局灶性骨溶解.Kaplan-Meier分析假体的生存率1.0(95%可信区间,0.98～1.0).[结论]非骨水泥型全髋关节置换术可为晚期酒精性股骨头坏死患者提供良好的中期临床效果.由于假体磨损、假体周围骨溶解等潜在因素,长期效果需要进一步随访.     

金对金全髋置换治疗中年患者晚期股骨头坏死疗效观察

[目的]探讨金属对金属全髋关节置换术治疗中年患者晚期股骨头坏死近期疗效。[方法]回顾性分析2008年1月～2009年9月对行金属对金属大直径股骨头全髋关节置换术的33例(36髋)股骨头缺血性坏死中年患者,男18例,女15例;平均年龄52.82岁(45～59岁)。双髋同时置换3例,单髋置换27例。假体均采用Corin公司的Optimom金属对金属轴承全髋关节置换系统。[结果]33例患者术后平均随访22.6个月(18～30个月)。Harris评分由术前的平均44.3分(24～83分)提高至随访末期的93.2分(91～96分)。末次随访X线片显示假体位置良好,未发现髋臼和股骨假体的无菌性松动和骨溶解,无异位骨化形成。[结论]金属对金属全髋关节置换术对中年、晚期股骨头坏死患者的早期疗效满意。     

非骨水泥全髋关节置换术治疗股骨头缺血性坏死的中期疗效评估

目的对使用非骨水泥型假体行全髋关节置换术(totalhiparthroplasty,THA)治疗的股骨头缺血性坏死患者进行术后中期的影像学及临床评估,回顾性研究非骨水泥型假体的疗效及其影响因素。方法对1998年1月至2001年3月,采用非骨水泥型假体行THA治疗的股骨头缺血性坏死患者71例(80髋)进行至少5年的随访。临床评估以Harris评分为标准。影像学评估根据术后随访时骨盆正位与髋关节正、侧位X线片,观察髋臼、股骨假体的位置及其周围骨质的改变,并测量臼杯内衬的磨损速度、磨损方向。假体的生存率采用Kaplan-Meier分析,分别以髋臼、股骨假体的无菌性松动和任何原因所致的翻修为终点。结果共54例(62髋)患者获得至少5年的随访,术前Harris评分平均为(44.0±8.4)分(21～50分),终末随访时平均为(92.4±5.7)分(78～100分)。截至末次随访时无一例翻修或表现为影像学无菌性松动。1髋出现骨盆局灶性骨溶解,12髋出现股骨局灶性骨溶解。聚乙烯内衬平均线性磨损率为(0.125±0.074)mm/年。Kaplan-Meier分析假体生存率为1.0(95%可信区间,0.98～1.00)。结论多孔涂层非骨水泥型假体可为晚期股骨头缺血性坏死患者提供良好的中期固定及临床效果。然而,因为聚乙烯髋臼的磨损不可避免及假体周围骨溶解等潜在因素的存在,长期效果仍须进一步随访。     

晚期股骨头坏死的人工关节置换术

[目的]探讨晚期股骨头坏死患者髋关节置换术的选择方法及其临床结果。[方法]对本科于1985年5月～2003年12门行髋关节置换术的119例（138髋）股骨头坏死患者进行了随访。使用人工双极股骨头置换术及THA治疗晚期股骨头坏死者分别为29例（31髋），90例（107髋）。所有手术均采用后外侧人路。[结果]早期使用的国产骨水泥人工双极股骨头假体，86．7％的股骨柄假体出现松动。全骨水泥THA，50％髋出现了髋臼杯似体松动，62．5％髋股骨柄似体松动，25％髋行全髋人工关节翻修术：混合型（Hybrid）THA，未出现髋臼杯及股骨柄似体的松动，非骨水泥THA，除1例外无髋臼杯及股骨柄假体松动或下沉。[结论]使用人工双极股骨头置换术治疗晚期股骨头坏死应慎重选择，可适用于老年、日常活动量小的患者；而对于年轻患者，非骨水泥型THA为最佳选择；对于股骨侧出现骨质疏松或不适合使用生物固定型股骨柄假体的患者，混合型（Hybrid）THA同样可以获得满意疗效；全骨水泥犁THA应很少使用。     

混合型初次人工全髋关节置换术的临床应用

目的探讨混合型初次人工全髋关节置换术的适应证及临床疗效。方法回顾性研究2004年1月至2007年12月施行混合型初次人工全髋关节置换术42例（45髋）,全部得到随访,临床资料完整,平均随访（34．1±1．2）个月,对假体生存率、Harris髋关节评分、疼痛、步态、大腿痛等方面进行评估。放射学资料完整者39例（42髋）,平均随访（31．5±1．6）个月,对假体放射学松动率、骨水泥鞘分级、异位骨化等方面进行评估。结果假体生存率为97．7％,以髋臼或股骨假体无菌性松动为观察终点,则假体生存率为100％。Harris髋关节评分比术前平均（48±20）分（10～85分）改善为平均（90±8）分（56～100分）,仅1髋股骨头坏死为轻度疼痛,其余44髋均为轻微疼痛或无疼痛。2例为中度跛行,10例为轻度跛行,30例无跛行。无一例出现大腿痛,无一例出现髋臼或股骨假体的放射学松动。2例（2髋）发生异位骨化,均为BrookerⅠ级。结论混合型初次人工全髋关节置换术治疗晚期髋关节疾患效果良好。     

混合型初次人工全髋关节置换术的短期随访研究

目的 探讨混合型初次人工全髋关节置换术的适应证及治疗效果.方法 回顾性研究2001年1月～2004年12月由同一术者施行的混合型初次人工全髋关节置换术患者63例( 80髋),失访5例(5髋),临床随访资料完整者58例(75髋),对假体生存率、Harris 髋关节评分、疼痛、步态、大腿痛等方面进行评估;放射学资料完整者49 例(64髋),对假体放射学松动率、骨水泥鞘分级、异位骨化等方面进行评估.结果 75例(58髋)术后获随访(33.9±1.3)个月平均(15～57个月),假体生存率为97.3%,以髋臼或股骨假体无菌性松动为观察终点,则假体生存率为100%.Harris 髋关节评分从术前的平均(46±20)分(10～85分)改善为平均(92±8)分(56～100分). 56例(73髋)患者中,术后95.9%的患者(70髋)无疼痛或仅有轻微疼痛.4例(7.1%)为中度跛行,14例(25%)为轻度跛行,38 例(67.9%)无跛行.无一例出现大腿痛、髋臼或股骨假体的放射学松动.49例(64髋)放射学资料完整患者股骨假体骨水泥鞘分级:A级37髋, B 级20髋,C1级4髋, C2级3髋.4例(4髋)发生异位骨化,均为Brooker I级.结论 混合型初次人工全髋关节置换术近期随访效果良好.     

应用组配式S-ROM假体行初次全髋关节置换术治疗严重髋关节发育不良

[目的]探讨应用非骨水泥型组配式S-ROM假体行初次全髋关节置换术治疗严重髋关节发育不良的近期疗效。[方法]对18例(19髋)严重髋关节发育不良患者应用S-ROM假体行初次全髋关节置换术。其中男性6例,女性12例,平均年龄32岁。按Crowe分型,CroweⅢ型11例11髋,CroweⅣ型7例8髋。手术采用在真臼位置磨锉加深重建髋臼,股骨侧选用S-ROM组配式假体,复位困难者行转子下截骨。术前和术后随访时应用Harris髋关节评分(Harris hip score,HHS)和影像学检查对髋关节功能进行评估。[结果]术中1例股骨近端裂缝骨折,用双股钢丝环扎固定。术后有2例出现坐骨神经牵拉症状,术后3个月内完全恢复。所有患者均得到有效随访,有1例患者大转子上方发生异位骨化,但不影响关节活动度,未发现感染、骨质溶解、假体松动、脱位等并发症。平均随访2.8年(6个月~5年)。HHS评分由术前平均38.4分增加到末次随访时的85.2分。[结论]S-ROM假体是治疗严重髋关节发育不良的理想选择,近期效果良好。     

非骨水泥假体髋关节翻修术随访报告

[目的]探讨非骨水泥假体在髋关节翻修术中的临床效果.[方法]对本科1997年11月～2007年8月行非骨水泥人工全髋关节翻修术36例(41髋)患者进行了随访,其中29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄.随访X线片上的假体变化情况,分析AAOS、Paprosky骨缺损分类对翻修时假体选择的指导作用,对髋关节行Harris功能评定并分析假体生存率.[结果]24例28髋获得随访,平均随访4.6年(1～11年),患者平均Harris评分由术前的38分(11～76分)增加到末次随访时的88分(60～99分).21髋(75%)假体获得良好稳定性;1髋股骨1区形成2 mm宽的透亮线,临床检查无松动迹象;4髋发生骨溶解并假体移位(股骨1髋,髋臼3髋)而需要再翻修,失败率为12.5 %;8髋发生异位骨化;聚乙烯衬垫年平均磨损量为0.08 mm(0～0.25 mm),磨损率仅与外展角变化存在相关.AAOS分类术前、术中的一致性较Parprosky分类高.分别以任何原因进行了再翻修和影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析计算假体4.6年存活率分别为89%、81%.[结论]非骨水泥型假体可用于初次髋关节置换术失败的翻修.术中对骨缺损进行细致的评估并选择合适的假体固定,能达到令人较满意的临床效果.     

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。     

全髋置换术治疗Perthes病后遗症的中期临床结果

[目的]评价全髋置换术治疗Perthes病后遗症的中期临床疗效和影像学结果。[方法]对2004年2月~2013年10月间因Perthes病继发髋关节骨关节炎而行全髋置换术的33例患者(33髋)进行回顾性分析,其中男性18例18髋和女性15例15髋,患者手术时平均年龄46.8岁(24~72岁),全部病例均采用非骨水泥型臼杯重建髋臼和非骨水泥柄重建股骨近端,其中11髋使用组配式股骨假体。临床结果采用Harris髋关节评分进行评价,影像学结果依据术后系列X线片进行评估。[结果]平均随访时间53.4个月(26~136个月),Harris髋关节评分从术前平均37.6分(15~56分)提高至术后最后一次随访的92.8分(70~100分)(P0.001)。术后有7例患者仍然存在中度至重度跛行。围手术期并发症包括坐骨神经损伤1例和术中股骨距骨折4例,未发现假体无菌性松动及深部感染病例。[结论]尽管技术上存在众多难点,但全髋关节置换术治疗Perthes病后遗症的中期临床和影像学结果令人满意,某些并发症发生率高值得关注。     

比较人工全髋关节置换在治疗股骨头缺血性坏死和类风湿性关节炎中的作用

目的评估人工全髋关节置换（THA）在治疗股骨头缺血性坏死（AVN）和类风湿性关节炎（RA）中的作用。方法采用非骨水泥型THA治疗的42例（50髋）AVN和40例（50髋）RA患者,分别进行临床和影像学比较。临床随访包括Harris评分、术后翻修率和并发症分析;影像学评估包括骨溶解、聚乙烯臼杯磨损率分析。结果患者均获随访,时间5～10年。临床随访结果：AVN组和RA组Harris评分由术前（49.59±9.03）分和（48.76±7.61）分,术后分别提高到（90.76±5.64）分和（87.18±6.83）分,较术前均明显提高,但两组间Harris分值提高差异无统计学意义（P〉0.05）;AVN组和RA组术后翻修率分别为6%（3髋）和8%（4髋）,并发症分别为6%（3髋）和10%（5髋）,两组间差异无显著性（P〉0.05）。影像学结果：聚乙烯磨损率AVN组明显高于RA组,分别为（0.15±0.11）mm/年和（0.10±0.09）mm/年,两组比较差异有统计学意义（P〈0.05）;髋臼侧骨溶解发生率AVN组明显高于RA组,分别为18%（9髋）和4%（2髋）,两组比较差异有统计学意义（P〈0.05）;而股骨侧假体骨溶解发生率分别为20%和12%,两组比较差异无统计学意义（P〉0.05）。结论非骨水泥型THA在AVN和RA随访中均取得了良好的疗效,但AVN组髋臼侧聚乙烯内衬磨损和髋臼骨溶解高于RA组。     

Revision total hip arthroplasty for pelvic osteolysis with well-fixed cementless cup

Treatment of pelvic osteolysis after total hip arthroplasty (THA) remains controversial. Clinical and radiographic outcomes of revision THA were evaluated in 62 hips with pelvic osteolysis and well-fixed cementless cups. The patients' mean age was 50.9 years, and the mean interval from primary to revision THA was 9.7 years. For revision, cementless cups were used in 51 hips, and cemented cups in 11 with acetabular reinforcement rings in 9. The mean duration of follow-up after revision THA was 5.9 years (range, 3.0-9.7 years). At final follow-up, the average Harris Hip Score was 92.4, and there was no radiographic complication except for 1 with change of inclination. Revision THA for pelvic osteolysis with well-fixed cementless cups showed favorable outcomes, and it can be preferentially used in young patients.     

Ceramic on ceramic hip arthroplasty in fused hips

Background:Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips.Results:Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking.Conclusion:This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results.     

Cementless Total Hip Arthroplasty in Patients with Osteonecrosis After Kidney Transplantation

This study was to determine the mid- to long-term survivorship of cementless metal-on-metal THA in 52 patients (74 hips) who underwent THA for osteonecrosis of the femoral head with a cementless THA. The mean follow-up was 10.2 years. The mean age at operation was 42.1 years (range, 25–62 years). The survivorship analysis with revision as the end point estimated a 96.6% chance of THA survival during 16.4 years. The average Harris hip score at last follow-up was 89.2 points (range, 74–100). Two patients (two hips) required revision surgery for extensive acetabular osteolysis at 9 years and acetabular liner dissociation at 2 years. The survival rates of cementless THA in these patients are encouraging. However, the possibility of metallic wear related complications are raising concern.     

Outcome of Total Hip Arthroplasty for Avascular Necrosis of the Femoral Head in Systemic Lupus Erythematosus

This study evaluated the result of total hip arthroplasty (THA) for avascular necrosis of the femur head (AVNFH) in systemic lupus erythematosus (SLE) patients. Nineteen THAs were performed on 13 patients with SLE. The results of these patients were compared with the results of the control group (19 patients) who had THR due to AVNFH with none-SLE conditions. The Harris hip score increased from a preoperative average of 65.3 points to 94.9 at the most recent follow-up. In the control group, the mean HHS was 67.2 preoperatively and 96.1 postoperatively at the last follow-up. No significant difference was found between SLE patients and non-SLE patients who underwent hip arthroplasty. In conclusion, THA is an acceptable treatment for achieving functional improvement in patients who had SLE and AVNFH.     

解剖型非骨水泥全髋人工关节置换术近中期疗效研究

目的探讨解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病的近中期临床疗效。方法2001年1月~2005年6月,采用Ribbed解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病34例(38髋)。年龄29~55岁,平均42.7岁。病程3~18年,平均5.2年。其中股骨颈骨折7例7髋,髋臼骨折后创伤性关节炎5例5髋,股骨头坏死15例16髋,强直性脊柱炎7例10髋。术后获随访的21例患者术前Harris评分25~57分,平均38.6分。结果21例(23髋)获随访8~61个月,平均35个月。术后Harris评分76~98分,平均92.3分,与术前比较差异有统计学意义(P<0.05);术后髋关节功能优良率达93.5%。其中4例出现轻微大腿疼痛,经休息或服用非甾体类止痛药物后缓解。随访时X线片未见假体松动和下沉,呈骨长入性稳定。结论应用Ribbed解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病,近中期效果满意。     

Fifteen-Year to Twenty-Year Results of Cementless Harris-Galante Porous Femoral and Harris-Galante Porous I and II Acetabular Components

This study examined long-term survivorship of primary total hip arthroplasty (THA) using cementless Harris-Galante porous femoral and Harris-Galante porous I or II acetabular components. Of 113 hips (101 patients) studied, 60 hips (53 patients) were available for follow-up at a mean of 17.2 years after surgery. A total of 10 hips had documented revision, and 2 hips had failed radiographically. The average Harris hip score was 82. Radiographically, 12 hips demonstrated eccentric wear, 8 had osteolysis, and 1 had a broken tine. The overall survival rate was 87.7%; the mean volumetric wear rate was 74.96 mm³; and the mean polyethylene linear penetration rate was 0.153 mm/y, similar to that of well-cemented THA in other series. This long-term outcome for an early-generation cementless THA is promising and provides a standard by which to judge the newer generation of cementless implants.     

A Simple Method Using a PACS to Minimize Leg Length Discrepancy in Primary THA : A Method to Minimize Leg Length Discrepancy

We determined whether a PACS-based method (head-lesser trochanter distance [HLD]) better equalized leg length discrepancy (LLD) after primary THA than a conventional method. We retrospectively reviewed 312 patients (379 hips) with osteonecrosis or primary osteoarthritis who underwent primary cementless THA: 198 patients (240 hips) underwent THA using the HLD method, while the conventional group consisted of 114 patients (139 hips) in whom we measured with the method of McGee and Scott. We then compared the LLDs in the two groups. We observed no difference in the mean postoperative LLD. A higher percentage of patients in the HLD group had an LLD less than 6 mm: 81% vs 68% hips, respectively. HLD method decreases the possibility of an LLD over 6 mm after THA.     

Hip Osteonecrosis: Does Prior Hip Surgery Alter Outcomes Compared to an Initial Primary Total Hip Arthroplasty?

The purpose of this study was to assess the clinical and radiographic outcomes of total hip arthroplasty (THA) in patients who had osteonecrosis to see if prior hip preserving surgery affected outcomes. Implant survivorship, Harris hip scores, and radiographic outcomes were compared between 87 patients (92 hips) who had undergone prior hip preserving procedures and 105 patients (121 hips) who had only undergone THA. Patients were also sub-stratified into low- and high-risk groups for osteonecrosis. At a mean follow-up of 75 months, there were no significant differences in survivorship, clinical, and radiographic outcomes among the cohorts. Higher revision rates were associated with patients who were in the high-risk group. The authors believe that hip joint preserving procedures may not adversely affect the outcomes of later THA in patients with osteonecrosis.     

Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur

BackgroundTotal hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique.MethodsFifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5).ResultsFemoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up.ConclusionThe trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.