非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形△

Total hip arthroplasty without femoral shortening osteotomy for end- stage arthrosis complicated with femoral head and neck shortening deformity

摘要:

[目的]介绍非股骨短缩截骨全髋置换治疗股骨头颈短缩畸形的手术技术和初步临床效果。[方法]对 19 例股骨头颈短缩畸形患者采用非股骨短缩截骨全髋置换治疗。手术采用后外侧入路，先切开并松解粘连挛缩的髋关节囊，充分显露髋臼，确定真性髋臼位置并行髋臼成形或再造，安放髋臼假体；适配型号的股骨柄试模置入后安放递增长度的股骨头进行髋关节复位，在保持髋关节张力的情况下触摸髋关节周围挛缩的软组织并依次松解，随后置入适配的股骨柄及股骨头假体，复位髋关节。[结果]19 例患者均顺利完成手术。术后均实现髋臼及股骨柄生物性压配与初始稳定，无严重并发症。术后随访 6~36 个月。 术后 6 个月随访时患者 Harris 评分为(94.5±4.7)分，临床效果评定：优 15 例、良 4 例，优良率 100%。术后影像显示所有患者均保持解剖位旋转中心，假体位置良好，术后 3 个月 X 线片均示广泛性骨长入，随访期间均未发生脱位、假体柄移位及断裂。 [结论]全髋关节置换术不行股骨缩短截骨治疗终末期关节合并股骨头、颈缩短畸形技术可行，短期疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of total hip arthroplasty (THA) without femo- ral shortening osteotomy for end-stage arthrosis complicated with femoral head and neck shortening deformity. [Methods] A total of 19 pa- tients received THA for end-stage hip arthrosis complicated with femoral head and neck constriction deformity. A posterolateral approach was used to expose the hip complicated with severe deformity. Identifying the location of the true acetabulum, the poorly developed acetabu- lum was reconstructed with autologous femoral head, reamed and then implanted with the acetabular components in proper position. After contracted soft tissues around the joint were released successively, the proximal femur was prepared and inserted with femoral stem in proper size. After trial, the femoral head component in suitable length was installed, and the joint was reduced with proper stability and motion. [Results] All the 19 patients had THA performed successfully with good initial stability of acetabulum and femoral components without serious complications, and followed up for 6 to 36 months. Six months after the operation, the Harris score was of (94.5±4.7) , while the clinical out- come was graded as excellent in 15 cases and good in 4 cases, with an excellent and good rate of 100%. In term of imaging, all the patients maintained the hip center of rotation in anatomic position, and had prosthesis in proper position, got obvious bone ingrowth of the prosthesis 3 months after surgery, without dislocation, stem displacement or fracture during follow- up. [Conclusion] Total hip arthroplasty without femoral shortening osteotomy is feasible technique for treatment of end-stage arthrosis complicated with femoral head and neck shortening deformity, does achieve satisfactory short-term clinical outcome.