保留股骨颈全髋关节置换的手术体会

目的探讨保留股骨颈的全髋关节置换在临床应用中的手术体会。方法2002年1月至2007年2月，12例13侧因各种原因需行全髋关节置换者接受了保留股骨颈的全髋关节置换，采用Gibson切口，在头下位置将股骨头截断，保留完整的股骨颈。选择合适的外杯，55°外翻角装入。内杯为超高分子聚乙烯，超半径设计保持外翻45°。术前、术后及随访中对患者髋关节功能进行Harris评分，随访时摄X线片以了解假体的位置、松动情况及异位骨化。结果全部患者获得1～4年的随访，13侧人工髋关节临床效果良好。人工髋关节的活动及功能良好，髋关节的Harris评分由术前的平均50分提高到末次随访时的平均91分；影像学检查显示人工髋关节位置良好，假体无松动和下沉。结论保留股骨颈的全髋关节置换术对因各种原因需行全髋关节置换者，是一种良好的选择，主要适用于无骨质疏松且股骨颈完整者。

Operative Experience of Preservation of Femoral Neck in Total Hip Arthroplasty

Objective To discuss the clinical application of preserving femoral neck in total hip arthroplasty and to operative experience. Methods From January 2002 to Febuary2007,12 patients underwent total hip arthroplasty with preservation of femoral neck. We cut off the femoral head in infra-head position with Gibson incisions to reserve intact neck of femur. Then suitable size of extra cup was selected and placed at 55 °eversion angle. The internal cup,made from ultra high polymer poly thene and with ultra radius design,was placed at 45°eversion angle. Harris scores were recorded before operation ,after operation and during the follow-up. During the follow-up ,the X-ray films were taken to assess position,loosening of the prosthesis and ectopicossification. Results All 8 patients were followed up 1-4 years. 13 cases of total hip arthroplasty with femoral neck preservation is good. The mean Harris score of hip elevated from 50 scores before operation to 91 scores of the last follow-up. The X-ray films were not taken to assess position,loosening of the prosthesis and ectopicossification. There was no prosthesis loosening and femoral prosthesis setting. Conclusion Total hip arthroplasty with femoral neck preservation is a good option for the patients who need total hip arthroplasty for variable reasons,which is indicated for the patients whose femoral neck is intact with no osteoporosis.