全髋表面置换术治疗股骨头坏死短期随访研究

目的：研究全髋表面置换术治疗股骨头坏死的短期疗效,探讨表面置换术治疗股骨头坏死技术要求和手术指征。方法：对2006年12月至2009年12月37例（43髋）行全髋表面置换术的股骨头缺血坏死患者进行随访,男25例,女12例;年龄21～67岁,平均44.5岁。按照ARCO进行分期：3A期3髋,3B期6髋,3C期16髋,4期18髋。根据Harris评分系统对手术前后关节疼痛、活动度、畸形矫正及功能的改善进行对比,用Charnley法比较术后假体松动X线改变。结果：失访3例,34例（40髋）获得随访,37髋疼痛完全缓解,3髋行走后有酸痛不适。随访时间16～53个月,平均32.4个月。术前Harris平均评分（51.5±1.7）分,术后32.4个月平均（94.3±1.4）分,较术前提高。优37髋,良3髋,差0髋。34例都恢复了正常生活或工作,术后疼痛明显缓解,其中3例（髋）长距离行走后有轻度酸痛不适,休息后缓解。1例异位骨化BrookerⅢ型,无疼痛,不影响正常行走和生活。无术后股骨颈骨折,无脱位,无松动和翻修。结论：经过适当患者选择、术中的精细操作,全髋表面置换术治疗股骨头缺血坏死可以获得满意的短期疗效。

Short-term result of hip resurfacing arthroplasty in the treatment of patients with femoral head necrosis

Objective: To study short-term results of hip resurfacing arthroplasty(HRA) in the treatment of patients with avascular necrosis of femoral head(ANFH),and to explore indication and strategy in this surgery. Methods: From December 2006 to December 2009,37 patients(43 hips) with avascular necrosis of femoral head were treated with total hip resurfacing arthroplasty. Among the patients,25 patients were male and 12 patients were female,with an average age of 44.5 years (ranged,21 to 67 years). According to ARCO classification,3 hips were 3A stage,6 hips were 3B stage,16 hips were 3C stage and 18 hips were 4 stage. X-ray evaluation of the patients were conducted. The clinical results were evaluated by the Harris hip score system including pain,range of motion,correction of deformity and total function. Results: Thirty-four patients(40 hips) were followed up with an average period of 32.4 months (ranged,16 to 53 months),and 3 patients were lost. Thirty-seven hips got complete relief of joint pain and 3 patients feel aching pain after walking. There was 1 heterotopic ossification,no femoral neck fracture,no dislocation,no infection and no revision in all patients. From pre-operation to present,the average Harris hip score improved significantly from (51.5±1.7) to (94.3±1.4). Thirty-seven hips got an excellent result,3 hips good and no poor. Conclusion: The total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients with ANFH,and the short-term results are satisfying.