定制型人工髋关节置换治疗股骨近端瘤性病变

目的探讨定制型人工髋关节置换治疗股骨近端瘤性病变的经验及临床效果。方法1994年2月~2002年11月,对11例股骨近端瘤性病变行股骨近端切除、带部分股骨假体的人工髋关节置换术。男7例,女4例。年龄40~69岁。左侧9例,右侧2例。其中股骨近端骨巨细胞瘤7例,软骨母细胞瘤2例,畸形性骨炎1例,骨纤维异常增殖症1例。行人工全髋关节置换6例,双极杯人工股骨头置换5例。结果术后9例获随访1~5年,2例失访。1例术后创面渗血、股部近端连续加压包扎5d后股四头肌功能丧失,股前部感觉消失;术后5年随访股四头肌肌力0级,股前部感觉减退,绳肌及小腿伸屈肌群肌力3级,跛行,需扶拐行走。5例股四头肌肌力3级,其中2例感觉股部近端阵发性疼痛,尤以久站及行走后疼痛明显,均为双极杯股骨头假体置换者;3例股四头肌力4级。8例髋关节外展10~27°,髋关节屈曲,平均74°。采用Harris标准评定,良(80~89分)3例,中(70~79分)5例,差(70分以下)1例。术后无感染,随访期间无肿瘤复发及假体松动。结论定制型人工髋关节置换治疗股骨近端瘤性病变是一种有效方法,但术后股四头肌无力发生率较高,与股四头肌上部附着处丢失有关。术中将股四头肌,特别是其附着的内、外、后肌间隔贯穿固定于假体体部,可望有效改善股四头肌肌力。

TREATMENT OF TUMOROUS DISEASE IN PROXIMAL FEMUR BY CUSTOMIZED HIP ARTHROPLASTY

OBJECTIVE: To summarize and analyze the clinical experience and the clinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. METHODS: Eleven patients (7 males and 4 females, aged 40-69 years) with a tumorous disease in the proximal femur received a removal of the proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. RESULTS: The follow-up for 1-5 years in 9 patients (2 patients lost the follow-up) revealed that after operation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the "0" degree, a decreased sensation, the "3" degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle power test showed that 5 patients had the "3" degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the "4" degree of the quadriceps muscle power, with an extension range of the hip joint of 10 degrees-27 degrees and an average flexion degree of 74 degrees. According to the Harris scale, 3 patients were assessed to be good (80-89), 5 moderate (70-79), but 1 bad (<70). No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. CONCLUSION: The customized hip arthroplasty has a good clinical outcome in treatment of a tumorous disease in the proximal femur. However, there is a high incidence of deficiency of the quadriceps muscle power after operation, which may be relevant to the removal of the upper attachment of the quadriceps muscle. If the attachment of the quadriceps muscle, especially the internal, external and posterior septum attachment, can be fixed in the body of the prosthesis during operation, the power of the quadriceps muscle can be enhanced and the patient can have a better therapeutic effect.