全髋置换术治疗晚期股骨头缺血性坏死

目的评价全髋置换术(THA)治疗不同原因引起的晚期(Ficat Ⅲ、Ⅳ)股骨头缺血性坏死(AVN)的疗效.方法41例(55髋)行初次生物型全髋置换术患者(男24例,女17例,平均年龄48.5岁)分为两组,第1组为无系统性疾病组(包括创伤后和特发性的股骨头AVN),共17髋,第2组为有系统性疾病组(乙醇中毒、服用类固醇激素、镰状红细胞性贫血引起的股骨头AVN),共38髋.两组随访时间、体重、Ficat分期和所用的假体差异无统计学意义(P＞0.05).采用Harris髋评分系统评估临床疗效,连续的X线观察评估股骨侧假体的移位与稳定性.结果38例52髋获得随访,第1组平均随访时间(40.0±7.5)个月,第2组平均随访时间(38.0±6.6)个月.术后Harris评分平均为(86.8±9.4)分,其中优30髋,良9髋,一般10髋,差3髋;第1组平均(91.6±8.9)分,第2组(84.4±10.1)分,差异有显著性统计学意义(P＜0.05).股骨侧假体平均下沉(2.55±1.23)mm,第1组(1.75±1.43)mm,无一例因无菌性松动行股骨侧假体柄翻修,第2组(2.63±1.11)mm,6例(8髋)因无菌性松动行股骨侧假体柄的翻修,两组股骨侧假体平均下沉差异有显著性统计学意义(P＜0.05).结论全髋置换术是治疗晚期股骨头缺血性坏死的有效方法,特发性或创伤后股骨头缺血性坏死的术后效果好于由类固醇、乙醇、镰状红细胞贫血引起的股骨头缺血性坏死,对后者应进行严密的监测,以便及早进行手术干预.

Total hip arthroplasty for the treatment of advanced avascular necrosis of femoral head

Objective: To evaluate the effect of total hip arthroplasty(THA) on the treatment of advanced avascular necrosis(AVN) of femoral head caused by various lesions.Methods: Forty-one patients(55 hips) accepted THA,including 24 male,17 female with the mean age of 48.5 years,were divided into two groups.The first group(17 hips) was caused by trauma and idiopathic lesions and the second group(38 hips) caused by alcoholism,steroids and sickle cell anemia.There was no significant difference between the two group in follow-up period,body weight,Ficat classification and prosthesis used(P>0.05).The clinical effect and stability of the femoral prosthesis were evaluated according to standard of Harris score and serial X-ray of the hip respectively.Results: Thirty-eight cases(52 hips) were followed up with the mean of(40.0±7.5) months and(38.0±6.6) months in the first and second group respectively.The average Harris scoring was(86.8±9.4) in the 52 hips:excellent in 30 hips,good in 9,fair in 10,poor in 3.The average score of the first group was(91.6±8.9) and that of the second group was(84.4±10.1)(P<0.05).The average subsidence of prosthesis in the 52 hips was(2.55±1.23) mm.The average subsidence of prosthesis in the first and second group were(1.75±1.43) mm and(2.63±1.11) mm respectively(P<0.01).Six cases(8 hips) caused by looseing were revised in the second group and no loosening was found in the first group.Conclusion: THA is an effective modality for advanced AVN of femoral head.The postoperative effect in patients with AVN lesions caused by trauma and idiopathic lesions is better than that caused by alcoholism,steroids and sickle cell anemia.Close surveillance is required in the latter group so that early operative intervention is possible.