非股骨短缩截骨全髋关节置换治疗严重继发性股骨头颈短缩畸形
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1.甘肃省古浪县人民医院骨科;2.解放军联勤保障部队第九四〇医院骨关节外科

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甘肃省青年科技基金(20JR5RA588,21JR7RA014)


Total hip arthroplasty with no femoral shortening osteotomy for the treatment of the patients with severe secondary shortened deformities in femoral head and neck
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Affiliation:

1.Department of Orthopedics, Gulang County People&2.amp;3.#39;4.&5.s Hospital, Gansu Province;6.Department of Joint Surgery, 940th Hospital of Joint Logistics Support Force of PLA

Fund Project:

Gansu Youth Science and Technology Fund (20JR5RA588, 21JR7RA014)

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    摘要:

    目的 探讨采用非股骨短缩的全髋关节置换术治疗严重继发性股骨头颈短缩畸形的手术操作方法和临床疗效。 方法 2019年8月至2022年3月,采用全髋关节置换术治疗成人严重继发性股骨头颈短缩畸形患者19例(19 髋),其中原发病为化脓性髋关节炎遗留继发骨关节炎9例,髋关节外伤脱位导致股骨头颈短缩畸形5例,Legg-calve-Perthes病遗留股骨头颈短缩5例。本组男7例,女12例;年龄22岁~52岁,平均37.6±3.2岁。全髋关节手术均采用后外侧入路,先切开并松解粘连挛缩的髋关节囊,确认真髋臼位置并进行髋臼成型或再造,安放髋臼假体;股骨柄试模植入后安放短颈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进行依次松解。术后定期门诊随访髋关节功能及X线平片,观察假体位置及假体-骨界面的骨愈合情况,Harris髋关节评分评估髋关节功能。结果 术后随访6~38个月,平均21.5月。末次随访时均无假体松动、失败等并发症发生,双侧腿长差和骨盆倾斜度逐渐得到纠正,步态恢复正常。Harris髋关节评分由术前(48.1±3.2)分改善至术后6个月的(94.5±4.7)分,有统计学差异(P<0. 01)。19例髋关节置换术后均实现髋臼及股骨柄的生物性压配与初始稳定性,术后3个月随访X线片上均获得良好的骨长入。 结论 对成人严重继发性股骨头颈短缩畸形患者进行非股骨短缩截骨的人工髋关节置换时,应着重进行髋关节周围骨与软组织的有效松解,对髋关节囊及周围挛缩的软组织进行分层松解安全、有效。

    Abstract:

    Objective To evaluate the manipulation technique and clinical outcome of total hip arthroplasty (THA) with no femoral shortening osteotomy for secondary shortened deformities in femoral head and neck. Methods Between August 2019 to March 2022, 19 patients (19 hips) with secondary shortened deformities in femoral head and neck were treated with THA, including 7 males and 12 females, with an average age of 37.6±3.2 years (range, 22 to 52 years), The primary diseases were suppurative hip arthritis in 9 cases, traumatic dislocation of the hip joint in 5 cases, and Legg-calve-Perthes disease in 5 cases. The THA were accomplished through posterolateral approach. First, the adhesion contracture of the hip capsule was dissected and released, the acetabulum was reconstructed or reconstructed after confirming the real position of the acetabulum. After the femoral stem test model was implanted, the short neck femoral head was placed for hip joint reduction. The soft tissue contracture around the hip joint was touched and released successively while maintaining the tension of the hip joint. The hip joint function and X-ray film were followed up regularly after operation to observe the prosthesis position and bone healing at the prosthesis - bone interface. The Harris hip score was used to evaluate the hip joint function. Results All of patients were followed up for 6-38months, average 21.5 years. No loosening or failure of component occurred,and the leg?length discrepancy of the bilateral sides and the pelvic obliquity was corrected gradually and the gait returns to normal by the end of follow-up. The Harris hip score was improved from preoperative 48.1±3.2 to 94.5±4.7 half year postoperatively, with significant differences (P<0.01). All prostheses acquired bone stabilization with no sign of loosening at 3 months postoperatively on X-ray. Conclusion For adult patients with severe secondary femoral head and neck shortening deformity, hip arthroplasty without femoral shortening osteotomy should focus on the effective release of bone and soft tissue around the hip joint. It is safe and effective to release the hip capsule and soft tissue contracture around the hip joint by layers.

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  • 收稿日期:2022-10-13
  • 最后修改日期:2022-10-13
  • 录用日期:2022-12-08
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