股骨颈保留型人工髋关节置换42例：5年同一机构治疗者≥12个月结果随访

背景：继往的人工髋关节置换切除股骨颈，将严重改变压应力系统和张应力系统之间的受力平衡。而保留股骨颈则保留了股骨颈健康骨结构，使假体应力沿股骨近端生理状况分布，亦可防止股骨近端骨质疏松导致假体松动。 目的：评价股骨颈保留型人工髋关节在髋关节置换中的应用效果。 方法：2003-03/2008-04施行股骨颈保留型人工髋关节置换42例52髋，均应用S-ROM假体(Depuy，美国)，假体分为髋臼部分和股骨部分。记录髋关节置换时间、术中出血量、置换后住院天数、Harris评分及围手术期并发症。置换后摄标准髋关节正侧位X射线片，并测量髋臼外展角和前倾角。 结果与结论：全部病例随访12~61个月，平均39个月。全髋关节置换时间30~70 min，平均45 min。术中出血70~200 mL，平均110 mL。置换后X射线片测量髋臼外展角平均44.1°，前倾角平均21°。置换后第5天髋关节摄片确认置入假体正常后即要求扶助行器下地活动。置换前髋关节功能Harris评分平均(32.7±6.3)分，置换后3个月Harris评分平均(93.2±4.1)分。提示股骨颈保留型人工髋关节置换具有创伤小、出血少、符合人体生物力学、假体稳定、假体磨损小的特点，可以作为传统股骨柄的替代治疗。

Femoral neck preservation in total hip replacement in 42 cases: A more than 12-month follow-up in the same institute within 5 years

BACKGROUND: Femoral neck is resected in total hip replacement, which can change the force balance between pressure system and tensile stress system. Femoral neck preservation can maintain natural bone structure of femoral neck, keep the stress distributing along proximal end of femoral neck, and prevent prosthesis loosening result from osteoporosis at the proximal end of femoral neck. OBJECTIVE: To evaluate the effect of femoral neck preservation on total hip replacement. METHODS: Femoral neck preservation in total hip replacement was performed on 42 cases (52 hips) from March 2003 to April 2008. S-ROM prosthesis (Acetabular and femur part) was used in the operation. The operation duration, blood loss, average postoperative hospitalization, Harris scores and perioperative complications were observed. X-ray film was performed after replacement. The abduction angle and anteversion angle of the acetabular prosthesis was measured. RESULTS AND CONCLUSION: All the cases were followed up for 12-61 months with the average of 39 months. The operation duration was 30-70 minutes with the average of 45 minutes, and the blood loss was 70-200 mL with the average of 110 mL. Postoperative X-ray film showed that the abduction angle was 44.1° and the anteversion angle was 21°. All the patients were ambulatory 5 days after surgery with the help of walker. The preoperative Harris hip score was (32.7±6.3), which was (93.2±4.1) at 3 months after operation. Total hip replacement with preservation of femoral neck has the advantages of minimal invasion, less blood loss, good biodynamic harmony, excellent stability of the prosthetic hip, and less prosthesis wear. It can replace traditional total hip arthroplasty as a new option.