自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位16例

目的:观察自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位的疗效,评价髋臼骨缺损进行自体骨重建的优越性。方法:自2008年3月至2013年12月采用自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位16例(16髋),其中男11例,女5例;年龄41～72岁,平均56.3岁;病程3.6～37.2年;交通事故伤12例,坠落伤4例。所有患者进行系统跟踪随访,评定术后1个月髋关节疼痛指标、Harris评分及髋关节总活动度变化。结果:16例(16髋)均获随访,时间11～78个月,平均27.3个月。16例(16髋)术前髋关节总活动度(56.2±23.4)°,VAS评分86.3±7.2,Harris评分32.6±12.6;术后1个月髋关节总活动度(181.8±17.6)°,VAS评分11.1±2.6,Harris评分86.3±7.2,均较术前改善,术后解决了疼痛和髋关节功能受限,假体位置均完好。结论:自体股骨头植骨结合全髋关节置换术治疗陈旧性髋关节中心性脱位,髋臼的初始稳定性及远期稳定性均较好,自体骨植骨避免了异体骨的并发症,骨源合理利用,价格低廉,减轻了患者负担。

Autogenous femoral head bone grafting combined with total hip arthroplasty for the treatment of old dislocation of hip joint center in 16 cases

Objective:To study effects of autogenous femoral head bone grafting combined with total hip replacement for the treatment of old center dislocation of hip joint,and to evaluate the superiority of acetabular defect reconstruction with autogenous bone.Methods:From March 2008 to December 2013,16 patients(16 hips) with old center dislocation of hip joint were treated with autologous bone graft combined with total hip replacement. There were 11 males and 5 females,ranging in age from 41 to 72 years old,with an average of 56.3 years old. The duration of the disease ranged from 3.6 to 37.2 years. Twelve patients had injuries caused by traffic accidents and 4 patients were caused by falling down. The hip joint pain at the first month after operation,Harris score and hip joint movement of all patients were observed by using electronic case follow-up system.Results:All the patients were followed up,and the duration ranged from 11 to 78 months,with an average of 27.3 months. The postoperative hip joint movement of (56.2±23.4)°,VAS 86.3±7.2 and Harris score 32.6±12.6 were all better than preoperative (181.8±17.6) °,11.1±2.6 and 86.3±7.2. The joint pain was reduced and the function limitation was improved after operation,and the prosthesis position was good.Conclusion:When the autologous femoral head bone grafting combined with total hip arthroplasty is used to treat old hip central dislocation,the initial and long-term stability of acetabular bone grafting is good,and the technique can avoid allogeneic bone complications,bone source rationally and reduce the economic burden of patients.