精确匹配的半髋表面置换术治疗股骨头缺血性坏死

目的评价精确匹配的半髋表面置换术治疗股骨头缺血性坏死的疗效。方法回顾性分析41例(48髋)股骨头缺血性坏死患者的临床资料。其中男30例,女11例;年龄29～49岁,平均37岁。其中FicatⅢ期35髋,FicatⅣ期13髋,髋臼相对正常。41例患者(48髋)均采用金属半髋表面置换术。结果全部病例均获得随访,随访时间平均5.2年。平均UCLA髋关节功能评分明显改善(P=0.001),疼痛由术前的3.1分提高到9.1分;步行由4.4分提高到9.2分;活动由5.5分提高到7.1分。按UCLA评分标准,FicatⅢ期35髋术后的满意率为88.6%;FicatⅣ期13髋术后的满意率为69.2%(P=0.25)。8髋疗效差,UCLA髋关节功能评分无明显改善,术后X线检查发现7髋呈髋内翻植入了假体(插入的短柄与股骨轴线的夹角均小于130°)。假体的5年生存率为83.0%。结论在严格掌握手术适应证、提高手术技术的前提下,精确匹配的半髋表面置换术治疗股骨头缺血性坏死的疗效满意。

Precision-fit surface hemiarthroplasty of the hip for the treatment of the femoral head osteonecrosis

OBJECTIVE: To evaluate the outcome of precision-fit surface hemiarthroplasty in the treatment of femoral head osteonecrosis. METHODS: The clinical data of 41 patients (48 hip joints) with femoral head osteonecrosis were reviewed. Of them, 30 were male and 11 were female, average age was 37 years old (ranging from 29 - 49). Thirty-five patients were at Ficat stage III and 13 at Ficat stage IV, their acetabula were relatively normal. The 41 patients (48 hip joints) underwent precision-fit surface hemiarthroplasties. RESULTS: The mean duration of follow-up was 5.2 years. The average UCLA hip score at follow-up was improved significantly from 3.1 to 9.1 points for pain, 4.4 to 9.2 points for walking, and 5.5 to 7.1 points for activity (P = 0.001). The satisfaction rate was 88.6% for 35 at Ficat stage III, 69.2% for 13 at stage IV (P = 0.25). Eight hips failed; the UCLA hip score was not improved significantly; the postoperative X-ray examination showed that 7 femoral prostheses were implanted in a varus orientation (the angle between the femoral prosthesis stem and the anatomic axis of the femoral shaft was lower than angle of 130 degrees). Five-year survival rate was 83.0%. CONCLUSIONS: Precision-fit surface hemiarthroplasty of the hip has the satisfactory result in treatment of the femoral head osteonecrosis on the basis of observing strictly operative indications and improving operative technique.