CAJ | 학술논문

目的评价无柄人工髋关节置换术的早期随访结果,探讨其临床应用的安全性及可行性.方法 2002年2月至2007年3月,对51例56髋施行无柄人工髋关节置换术.男31例34髋,女20例22髋;年龄25～87岁,平均56.2岁.术前髋关节Harris评分平均(72.4±8.4)分.新鲜股骨颈骨折6例6髋,股骨颈骨折继发股骨头坏死4例4髋,股骨头缺血性坏死(FicatⅢ-Ⅳ期)34例37髋,强直性脊柱炎髋关节强直2例3髋,类风湿髋关节炎2例3髋,髋关节结核3例3髋.全髋关节置换50髋,半髋关节置换6髋.以Harris评分评价术后疗效,用Amstutz分区方法对X线片进行分区评价,观察假体位置及并发症情况.结果全部病例随访2～7年,平均4.8年.髋关节Harris评分平均(92.8+3.2)分,其中优44髋、良7髋、可4髋、差1例,优良率91%.术后第2,3天发生关节脱位2例,经手法复位成功;术后40天发生感染1例,行关节腔病灶清除及持续关节腔冲洗后治愈;术后半年髋区疼痛1例,行有柄全髋关节翻修.随访期间X线片未见关节松动、脱位及螺钉松动、断裂等情况.结论无柄人工髋关节置换术可保留股骨颈,创伤小、出血少易于于翻修,适合高龄体弱及年轻患者.早期疗效可靠,远期疗效有待进一步观察.
목적 평개무병인공관관절치환술적조기수방결과,탐토기림상응용적안전성급가행성.방법 2002년2월지2007년3월,대51례56관시행무병인공관관절치환술.남31례34관,녀20례22관;년령25～87세,평균56.2세.술전관관절Harris평분평균(72.4±8.4)분.신선고골경골절6례6관,고골경골절계발고골두배사4례4관,고골두결혈성배사(FicatⅢ-Ⅳ기)34례37관,강직성척주염관관절강직2례3관,류풍습관관절염2례3관,관관절결핵3례3관.전관관절치환50관,반관관절치환6관.이Harris평분평개술후료효,용Amstutz분구방법대X선편진행분구평개,관찰가체위치급병발증정황.결과 전부병례수방2～7년,평균4.8년.관관절Harris평분평균(92.8+3.2)분,기중우44관、량7관、가4관、차1례,우량솔91%.술후제2,3천발생관절탈위2례,경수법복위성공;술후40천발생감염1례,행관절강병조청제급지속관절강충세후치유;술후반년관구동통1례,행유병전관관절번수.수방기간X선편미견관절송동、탈위급라정송동、단렬등정황.결론 무병인공관관절치환술가보류고골경,창상소、출혈소역우우번수,괄합고령체약급년경환자.조기료효가고,원기료효유대진일보관찰.
Objective To evaluate the short-term follow-up results of stemless hip arthroplasty and discuss its security, feasibility and validity in clinical application. Methods From February 2002 to March 2007, 51 patients (56 hips) underwent hip arthroplasty using stemless prostheses, including 31 males (34 hips) and 20 females (22 hips) with an average age of 56.2 years (range, 25 to 87 years). The mean preoper-ative Harris hip score was 72.4 ±8.4. There were fresh femoral neck fractures occurring in 6 patients (6 hips), avascular necrosis of femoral head after femoral neck fractures in 4 (4 hips), aseptic necrosis of femoral head (Ficat ID -IV) in 34 (37 hips), ankylosing spondylitis in 2 (3 hips), rheumatoid arthritis in 2 (3 hips) and hip tuberculosis in 3 (3 hips). Total hip arthroplasty were taken in 50 hips and femoral head replacement in 6 hips. The clinical effects were evaluated basing on Harris score and radiographic analysis according to Amstutz's zoning method for the stem and cup implant. Results All the patients were followed up, with a mean period of 4.8 years (range, 2 to 7 years). According to the Harris hip scoring system, the mean score was 92.8±3.2 after operation. There were 44 hips rated as excellent, 7 as good, 4 as fair, and 1 as poor. The excellent-good rate was 91%. Two patients dislocated at 2 and 3 days after operation, respectively, and who both gained manual reduction successfully. One patient got infected at 40 days after operation, and was cured by focal cleaning and continuous lavage of the joint cavity. Hip pain occurred in 1 case after operation and relieved after revision using femoral prosthesis with stem. X-ray showed no prosthesis loosening, disloca-tion or breakage of screws in these cases during follow-up. Conclusion Stemless hip arthroplasty is charac-terized by preservation of femoral neck, less surgical trauma, less blood loss, less complications and fitting f or revision. It is especially suitable for the old and weak cases or the young who need hip replacement. The follow-up results of 2 to 7 years showed its reliable effect, and the long-term outcomes need further e-valuation.