全髋置换术中髋臼内陷的处理

目的探讨人工全髋关节置换术中髋臼内陷的处理方法及早期疗效。方法 2006年7月至2012年12月,收治继发性髋臼内陷症21例28髋,男12例17髋,女9例11髋;年龄26~68岁,平均56.3岁;原发疾病:类风湿关节炎9例14髋,强直性脊柱炎6例8髋,感染4例4髋(结核和化脓性关节炎各2例2髋),髋臼骨折畸形愈合2例2髋;轻度髋臼内陷6髋、中度髋臼内陷12髋、重度髋臼内陷10髋。患者均行人工全髋关节置换,术中单纯植入生物型臼杯6髋,打压植骨后直接植入生物型臼杯18髋,直接植入骨水泥杯2髋,打压植骨后骨水泥杯固定2髋。结果术后21例28髋切口均一期愈合,无感染及下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间12~78个月,平均42个月。末次随访时,髋关节Harris评分为(87±4.1)分,术前Harris髋关节评分平均(45±3.3)分,较术前有显著差异,优22髋,良6髋,优良率100%。臼杯平均外翻角(42±3.5)°。植骨均骨性融合,无臼杯再次内陷及松动。髋关节活动度增加:屈曲增加(64.3±4.5)°,外展增加(20.5±3.5)°,内旋增加(16.5±2.5)°,外旋增加(19±2.5)°。末次随访时X线片显示所有假体均获得骨性稳定。术前股骨头内陷3~30 mm,平均13 mm;术后股骨头内陷0~5 mm,平均2 mm。人工股骨头旋转中心外移3~28 mm,平均10.5 mm。假体位置良好,无松动、下沉,植骨与髋臼融合,无髋臼再次内陷。结论人工全髋关节置换治疗髋臼内陷时,恢复患髋股骨偏心距及髋臼旋转中心,可获满意早期疗效。

Effectiveness of Total Hip Arthroplasty in Treating Protrusio Acetabuli

Objective To evaluate the result of total hip arthroplasty in the treatment of protrusio acetabuli. Methods From 2006. 7 to 2012. 12,21 cases（28 hips）of protrusio acetabuli were treated,including 12 males and 9 females with an av-erage age of 56. 3years（range,26 - 68years）. The preoperative Harris score was 45 ± 3. 3,there were 6 cases of mild,12 mod-erate cases,and 10 severe cases. All patients received total hip arthroplasty with recovery of femoral off set and acetabular cen-ter of rotation. Results All incisions healed without complication of infection,deep venous thrombosis,or nerve injury. All pa-tients were followed up 12 - 78 months with an average of 42 months. The Harris score at last follow-up was 87 ± 4. 1,showing significant difference when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsid-ence was observed,and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli,total hip arthroplasty with recovery the femoral off set and acetabular center of rotation and provide satisfactory early result.