中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2009年
5期
433-436
,共4页
黄彦%廖壮文%胡海阑%黄文铎%梁月屏%王胜标
黃彥%廖壯文%鬍海闌%黃文鐸%樑月屏%王勝標
황언%료장문%호해란%황문탁%량월병%왕성표
股骨头坏死,缺血性%关节成形术,置换,髋%前倾角畸形
股骨頭壞死,缺血性%關節成形術,置換,髖%前傾角畸形
고골두배사,결혈성%관절성형술,치환,관%전경각기형
Femoral head necrosis,iscbemic%Arthroplasty,replacement,hip%Femoral anteversion deformity
目的 探讨晚期股骨头缺血性坏死合并严重股骨颈前倾角畸形患者采用普通假体髋关节置换的手术方法及临床疗效.方法 本组男9例,女6例;年龄30~42岁,平均37岁.前倾角40°~50°,术前Harris评分(59±8)分,术中通过将股骨假体缩小前倾角20°~30°,同时将髋臼杯前倾角增大10°~15°,使其基本恢复正常对合关系,防止关节前脱位.术后定期影像学检查和临床疗效Harris髋评分.结果 术后15例患者均获得随访2.5~3.7年(平均2.9年),关节假体稳定性良好,关节活动度基本正常.术后2年Harris评分为(88±6)分,与术前相比,疗效显著(P<0.01).结论 晚期股骨头缺血性坏死合并严重股骨颈前倾角畸形患者手术中通过对普通的股骨假体及髋臼杯安放的角度的联合调整,使关节置换术后人工假体与髋臼的对合基本恢复正常,疗效显著,同时避免了使用小柄股骨假体、转子下截骨或使用特殊前倾角股骨假体等治疗方法.
目的 探討晚期股骨頭缺血性壞死閤併嚴重股骨頸前傾角畸形患者採用普通假體髖關節置換的手術方法及臨床療效.方法 本組男9例,女6例;年齡30~42歲,平均37歲.前傾角40°~50°,術前Harris評分(59±8)分,術中通過將股骨假體縮小前傾角20°~30°,同時將髖臼杯前傾角增大10°~15°,使其基本恢複正常對閤關繫,防止關節前脫位.術後定期影像學檢查和臨床療效Harris髖評分.結果 術後15例患者均穫得隨訪2.5~3.7年(平均2.9年),關節假體穩定性良好,關節活動度基本正常.術後2年Harris評分為(88±6)分,與術前相比,療效顯著(P<0.01).結論 晚期股骨頭缺血性壞死閤併嚴重股骨頸前傾角畸形患者手術中通過對普通的股骨假體及髖臼杯安放的角度的聯閤調整,使關節置換術後人工假體與髖臼的對閤基本恢複正常,療效顯著,同時避免瞭使用小柄股骨假體、轉子下截骨或使用特殊前傾角股骨假體等治療方法.
목적 탐토만기고골두결혈성배사합병엄중고골경전경각기형환자채용보통가체관관절치환적수술방법급림상료효.방법 본조남9례,녀6례;년령30~42세,평균37세.전경각40°~50°,술전Harris평분(59±8)분,술중통과장고골가체축소전경각20°~30°,동시장관구배전경각증대10°~15°,사기기본회복정상대합관계,방지관절전탈위.술후정기영상학검사화림상료효Harris관평분.결과 술후15례환자균획득수방2.5~3.7년(평균2.9년),관절가체은정성량호,관절활동도기본정상.술후2년Harris평분위(88±6)분,여술전상비,료효현저(P<0.01).결론 만기고골두결혈성배사합병엄중고골경전경각기형환자수술중통과대보통적고골가체급관구배안방적각도적연합조정,사관절치환술후인공가체여관구적대합기본회복정상,료효현저,동시피면료사용소병고골가체、전자하절골혹사용특수전경각고골가체등치료방법.
Objective To explore the operative method and clinical effect of total hip arthroplasty with normal prosthesis in treatment of the advanced stage avascular necrosis of femoral head combined with severe femoral anteversion. Methods There were 15 patients ( 15 hips) including nine males and six females, at age range of 30-42 years (mean 37 years). The femoral anteversion was 40°-50° and Harris score of (59 ± 8) points. Total hip arthroplasty with normal prosthesis was performed to reduce the femoral anteversion for 20°-30° and increase the acetabulum anteversion for 10°-15°so as to recover a good involution relationship of the femoral head and the acetabulum and avoid anterior dislocation. The imaging examination and Harris scoring were performed regularly postoperatively. Results A follow-up for mean 2.9 years (2.5-3.7 years) in 15 patients showed that all patients obtained good range of joint motion and good stability of all the hip prostheses. Harris score was (88±6) points at 2 years post-opera-tively, which was significantly better than preoperation (P < 0.01 ). Conclusions Total hip arthro-plasty with normal prosthesis can obtain good involution of the femoral head and the acetabulum in patients with advanced stage avascular necrosis of femoral head combined with severe femoral anteversion by simul-taneously regulating implant angle of femoral prosthesis and acetabular cup, which helps avoid use of small or specially made femoral stem or subtrochanteric derotational osteotomy.