骨保留型股骨柄假体在全髋关节置换术中的临床应用

目的 :探讨生物型全髋关节置换术采用Tri-Lock骨保留型股骨柄体在伴有股骨头颈短缩的髋臼内陷中的手术技巧和临床疗效。方法:2013年1月至2015年12月采用全髋关节置换术治疗10例(12髋)的髋臼内陷症患者,男5例(6髋),女5例(6髋);年龄42.5~67.5(51.6±3.0)岁。髋臼全部采用生物型假体陶瓷内衬,股骨头采用全陶瓷头。手术均采用后外侧切口,术后每年随访1次,置换术后行X线片检查评估假体柄位置,Harris评分评估髋关节功能。结果:10例患者术后获随访,时间8~48(33.0±3.5)个月。术中、术后无血管、神经损伤及骨折并发症发生。10例(12髋)术后均立即实现了髋臼及股骨柄的生物性压配。术后3个月X线片上均获广泛性骨长入,均可达到骨性固定,无松动和再次内陷发生。髋关节活动范围由术前(45.8±7.5)°增加至末次随访时的(90.0±6.5)°,其中屈曲增加至(89.0±6.0)°,外展增加至(35.5±7.3)°,内旋增加至(31.8±6.6)°,外旋增加至(32.6±5.2)°。Harris髋关节评分由术前45.7±7.5改善至末次随访91.5±8.5(t=144.832,P0.05)。结论:结合髋臼处理方法,Tri-Lock骨保留型股骨柄体在治疗伴有股骨头颈短缩的髋臼内陷症多合并严重髋关节周围软组织挛缩的患者中,可得到良好压配和保留更多骨质,术中需精细进行髋臼重建和软组织分层松解,术后中短期随访效果安全、满意。

Application of Tri-Lock bone preservation stem in acetabular protrusion combined with shorten defect of femoral head and neck

Objective: To evaluate the manipulation technique and clinical outcome of Tri-Lock bone preservation stem for acetabular protrusion combined with shorten defect of femoral head and neck.Methods: From January 2013 to December 2015,10 patients(12 hips) with acetabular protrusion combined with shorten defect of femoral head and neck were treated with total hip arthroplasty(THA) including 5 males and 5 female with an average age of(51.6±3.0) years old ranging from 42.5 to 67.5 years old. The acetabular prostheses were all biological prosthesis with the ceramic lining,the whole ceramic femoral head was used in all the cases. The posterior-lateral hip incision was adopted in the surgery. The follow-up was carried out in 12 months after the surgery,and later once a year. The Harris score system in growth of femoral side described was used to assess the joint function of the patients before and after the surgery.Results: Ten patients were followed up for 8 to 48 months with an average of 33.0±3.5. All the incisions healed well and there were no complications such as femoral fracture,infection,dislocation and neurovascular injuries. The biological compression of the acetabulum and the stem of the femur was realized immediately after operation in 10 patients(12 hips). X-ray at 3 months after the operation showed bone growth were extended in a wide range,which could achieve bone fixation,no loosening and re-invagination. The range of hip movement increased from (45.8±7.5)° to (90.0±6.5)° at the final follow-up,with flexion increased to (89.0±6.0)°,abduction increased to (35.5±7.3)° and internal rotation increased to(31.8±6.6)°,the outer rotation increased to(32.6±5.2)°. The mean Harris scores had improved from 45.7±7.5 pre-operatively to 93.5±8.0 post-operatively,there was statistically significant difference between before and after surgery (t=144.832,P<0.05).Conclusion: Combined with acetabular treatment,Tri-Lock bone retention of the femoral stem in the treatment of femoral head and neck with shortening of the acetabular retraction and severe hip joint soft tissue contracture in patients,could be well pressed and retained more bone. The reconstruction of the acetabulum and the delamination of soft tissue are required during the operation. The results were safe and satisfactory in the middle and short term follow-up.