肿瘤型与常规型人工全髋关节置换股骨假体安放的对比研究

目的通过对比两种人工全髋关节置换手术股骨假体安放的技术，提高对术中股骨假体安放及假体周围软组织修复的认识。 方法2012年1月至2016年1月，选取郑州市骨科医院骨病骨肿瘤科同期收治的髋部肿瘤、股股骨头坏死、股骨颈骨折行髋关节置换手术治疗的患者，排除肿瘤已全身转移且不宜手术治疗的患者，并随机分为对照组和观察组行人工全髋关节置换者90例95髋，男53例56髋，女37例39髋；年龄12～81岁，平均(55±14)岁。其中行肿瘤型人工全髋关节假体置换者(A组)12例12髋；行常规初次人工全髋关节置换者(B组)78例83髋。术中两组患者参照多处解剖标志安放股骨假体，并最大限度重建假体周围软组织解剖结构。对两组患者的手术时间、术中术后出血量、住院天数和髋关节Harris评分进行秩和检验和方差分析。 结果两组患者90例获3～30个月的随访，平均(36±7)个月的随访。在手术时间和术中术后出血量上两组比较差异无统计学意义(P>0.05)；住院天数两组比较差异有统计学意义(t＝2.027，P<0.05)。两组患者术前、术后Harris评分经统计学分析，差异有统计学意义(F＝4.662，P<0.05)，两组患者其术后髋关节功能得到提高，差异有统计学意义(F＝2.679，P<0.05)，术后B组患者的髋关节功能优于A组患者。随访期内两组患者均未发现术后下肢不等长、术后关节脱位、感染、假体松动、假体周围骨折、坐骨神经损伤等并发症。肿瘤型假体组1例由于外展肌力不全，出现行走步态异常。 结论股骨假体位置的正确安放及假体周围组织完整性的保持和术后重建恢复是术后髋关节获得良好功能的前提条件。

Comparative study on operation techniques of tumor type and conventional type femoral prostheses in total hip replacement

ObjectiveTo compare two techniques of femoral prosthesis positioning and the soft tissues repair during total hip arthroplasty(THA) and enhance the comprehension of the surgery. MethodsFrom January 2012 to January 2016, a series of 90 patients (95 hips) were enrolled in the study, including 53 males(56 hips) and 37 females (39 hips) of hip tumor, femoral head necrosis or femoral neck fractures, while the patients not suitable for operation were excluded. The average age was (55±14)years. The patients were divided into two groups. In the group of tumor femoral prosthesis (group A), there were 12 patients (12 hips). In the group of conventional femoral prosthesis (group B), there were 78 patients (83 hips). During the operation, the femoral prostheses were placed according to the reference of multiple anatomic landmarks, and the soft tissues around the artificial joint were reconstructed as far as possible. The perioperative data such as operative time, blood loss volume, hospital day as well as the Harris hip score were observed. Rank-sum test and chi-square test were applied for statistical analysis. ResultsThe two groups received three to 30 months of follow-up, and the average follow-up time was 21 months. No statistically significant difference was found between group A and group B in the operative time (t=1.014, P>0.05) or blood loss (t=1.922, P>0.05). The hospital day and the Harris hip score showed statistically significant differences between the two groups(t=2.027, P<0.05). The difference between pre-and postoperative Harris hip scores of the two groups was statistically significant(F=4.662 , P<0.05). The difference of Harris hip score between group A and group B was statistically significant(F=2.679 , P<0.05); group B was higher than group A. In the two groups, no leg length discrepancy, dislocation, postoperative infection, aseptic loosening, periprosthetic fracture, nerve injury or other complications was observed. One patient presented abnormal walking in group A, the cause might be the incomplete abductor strength. ConclusionsIt is a prerequisite for the femoral prosthesis being put at a correct position and for the tissues surrounding the artificial joint been reconstructed to obtain a good hip function after operation.