雙錐度生物固定型股骨柄治療髖關節骨性融合的療效_《中國修復重建外科雜志》

作者：

張強 , 劉明 , 柴偉 , 張國強 , 陳繼營 , 李眾利 , 董曉艷 , 周勇剛 , 王秀麗 , 王巖

解放軍總醫院骨科（北京，100853）;

關鍵詞：

人工全髖關節置換術骨性融合雙錐度生物固定型股骨柄

DOI：

10.7507/1002-1892.20130064

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的通過與解剖型股骨柄比較，探討對髖關節骨性融合患者采用雙錐度生物固定型股骨柄行人工全髖關節置換的療效。方法回顧分析1999年10月－2008年1月采用人工全髖關節置換治療的50例80髖髖關節骨性融合患者臨床資料，其中31例49髖采用BetaCone雙錐度生物固定型股骨柄（試驗組），19例31髖采用Ribbed解剖型股骨柄（對照組）。兩組患者性別、年齡、病程、術前Harris評分及關節外展角度比較，差異均無統計學意義（P gt; 0.05），具有可比性。術后X線片上測量兩組外展肌力臂（a）、重力臂（b），計算其比值，并分析假體穩定性；隨訪測量關節外展角度，行Harris評分。結果術中9例9髖（試驗組5例、對照組4例）發生骨折，經固定后骨折均愈合，假體穩定。術后患者均獲隨訪，其中試驗組隨訪時間12～98個月，平均49個月；對照組6～105個月，平均53個月。X線片復查示試驗組a/b為0.65 ± 0.25，對照組為0.56 ± 0.37，差異有統計學意義（t=2.19，P=0.03）；末次隨訪時假體位置穩定。術后6個月，試驗組關節外展角度為（34.49 ± 7.58）°，對照組為（30.97 ± 7.24）°，均較術前顯著改善（P lt; 0.05），組間比較差異亦有統計學意義（t=2.06，P=0.04）。術后兩組Harris評分均較術前顯著提高（P lt; 0.05），術后1個月試驗組評分優于對照組（t=3.62，P=0.01），但末次隨訪時兩組間差異無統計學意義（t=1.61，P=0.11）。術后2年試驗組12例14髖、對照組8例9髖發生1～2 級異位骨化。結論對于髖關節骨性融合患者，采用解剖型股骨柄及雙錐度生物固定型股骨柄行人工全髖關節置換均可獲得滿意療效，但雙錐度生物固定型股骨柄置換術后早期具有更好的關節外展功能。

引用本文： 張強,劉明,柴偉,張國強,陳繼營,李眾利,董曉艷,周勇剛,王秀麗,王巖. 雙錐度生物固定型股骨柄治療髖關節骨性融合的療效. 中國修復重建外科雜志, 2013, 27(3): 278-282. doi: 10.7507/1002-1892.20130064 復制

1.	Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty, 2008, 23(6): 859-866.
2.	Williams E, Taylor AR, Arden GP, et al. Arthroplasty of the hip in ankylosing spondylitis. J Bone Joint Surg (Br), 1977, 59-B(4): 393-397.
3.	Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
4.	Sweeney S, Gupta R, Taylor G, et al. Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol, 2001, 28(8): 1862-1866.
5.	李明清, 胡懿郃, 李康華, 等. 保留股骨頸型人工全髖關節置換的中期療效. 中國修復重建外科雜志, 2012, 26(8): 897-901.
6.	閔重函, 周瑛, 張洪美. 全髖關節置換術治療非功能位髖關節骨性強直12例17髖. 中國骨傷, 2011, 24(3): 231-235.
7.	宋立明, 于建華, 張鐵良. 人工全髖關節置換術治療強直性脊柱炎髖關節屈曲強直的臨床療效. 中國修復重建外科雜志, 2009, 23(2): 205-208.
8.	Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
9.	Johnston RC, Fitzgerald RH Jr, Harris WH, et al. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg (Am), 1990, 72(2): 161-168.
10.	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
11.	Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
12.	Idulhaq M, Park KS, Diwanji SR, et al. Total hip arthroplasty for treatment of fused hip with 90 degrees flexion deformity. J Arthroplasty, 2010, 25(3): 498. e5-498.e9.
13.	Kilgus DJ, Amstutz HC, Wolgin MA, et al. Joint replacement for ankylosed hips. J Bone Joint Surg (Am), 1990, 72(1): 45-54.
14.	Swanson MA, Huo MH. Total hip arthroplasty in the ankylosed hip. J Am Acad Orthop Surg, 2011, 19(12): 737-745.
15.	Bonin SJ, Eltoukhy MA, Hodge WA, et al. Conversion of fused hip to total hip arthroplasty with presurgical and postsurgical gait studies. J Arthroplasty, 2012, 27(3): 493. e9-493. e12.
16.	Dalury DF, Kelley TC, Adams MJ. Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. J Arthroplasty, 2012, 27(6): 1014-1018.
17.	Rhyu KH, Lee SM, Chun YS, et al. Does osteoporosis increase early subsidence of cementless double-tapered femoral stem in hip arthroplasty. J Arthroplasty, 2012, 27(7): 1305-1309.
18.	Costa CR, Johnson AJ, Mont MA. Use of cementless, tapered femoral stems in patients who have a mean age of 20 years. J Arthroplasty, 2012, 27(4): 497-502.
19.	Hwang BH, Lee WS, Park KK, et al. Straight tapered titanium stem with alumina bearing in cementless primary total hip arthroplasty: a minimum 5-year follow-up. J Arthroplasty, 2011, 26(8): 1310-1317.
20.	Scott RD, Sarokhan AJ, Dalziel R. Total hip and total knee arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res, 1984, (182): 90-98.
21.	Bangjian H, Peijian T, Ju L. Bilateral synchronous total hip arthroplasty for ankylosed hips. Int Orthop, 2012, 36(4): 697-701.
22.	Kim YL, Shin SI, Nam KW, et al. Total hip arthroplasty for bilaterally ankylosed hips. J Arthroplasty, 2007, 22(7): 1037-1041.
23.	Kilgus DJ, Namba RS, Gorek JE, et al. Total hip replacement for patients who have ankylosing spondylitis. The importance of the formation of heterotopic bone and of the durability of fixation of cemented components. J Bone Joint Surg (Am), 1990, 72(6): 834-839.
24.	Walker LG, Sledge CB. Total hip arthroplasty in ankylosing spondylitis. Clin Orthop Relat Res, 1991, (262): 198-204.
25.	崔旭, 張伯勛, 李靜東. 人工全髖關節置換術治療56例強直性脊柱炎的臨床研究. 中國矯形外科雜志, 2006, 14(9): 666-668.

1. Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty, 2008, 23(6): 859-866.
2. Williams E, Taylor AR, Arden GP, et al. Arthroplasty of the hip in ankylosing spondylitis. J Bone Joint Surg (Br), 1977, 59-B(4): 393-397.
3. Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
4. Sweeney S, Gupta R, Taylor G, et al. Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol, 2001, 28(8): 1862-1866.
5. 李明清, 胡懿郃, 李康華, 等. 保留股骨頸型人工全髖關節置換的中期療效. 中國修復重建外科雜志, 2012, 26(8): 897-901.
6. 閔重函, 周瑛, 張洪美. 全髖關節置換術治療非功能位髖關節骨性強直12例17髖. 中國骨傷, 2011, 24(3): 231-235.
7. 宋立明, 于建華, 張鐵良. 人工全髖關節置換術治療強直性脊柱炎髖關節屈曲強直的臨床療效. 中國修復重建外科雜志, 2009, 23(2): 205-208.
8. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
9. Johnston RC, Fitzgerald RH Jr, Harris WH, et al. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg (Am), 1990, 72(2): 161-168.
10. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
11. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
12. Idulhaq M, Park KS, Diwanji SR, et al. Total hip arthroplasty for treatment of fused hip with 90 degrees flexion deformity. J Arthroplasty, 2010, 25(3): 498. e5-498.e9.
13. Kilgus DJ, Amstutz HC, Wolgin MA, et al. Joint replacement for ankylosed hips. J Bone Joint Surg (Am), 1990, 72(1): 45-54.
14. Swanson MA, Huo MH. Total hip arthroplasty in the ankylosed hip. J Am Acad Orthop Surg, 2011, 19(12): 737-745.
15. Bonin SJ, Eltoukhy MA, Hodge WA, et al. Conversion of fused hip to total hip arthroplasty with presurgical and postsurgical gait studies. J Arthroplasty, 2012, 27(3): 493. e9-493. e12.
16. Dalury DF, Kelley TC, Adams MJ. Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. J Arthroplasty, 2012, 27(6): 1014-1018.
17. Rhyu KH, Lee SM, Chun YS, et al. Does osteoporosis increase early subsidence of cementless double-tapered femoral stem in hip arthroplasty. J Arthroplasty, 2012, 27(7): 1305-1309.
18. Costa CR, Johnson AJ, Mont MA. Use of cementless, tapered femoral stems in patients who have a mean age of 20 years. J Arthroplasty, 2012, 27(4): 497-502.
19. Hwang BH, Lee WS, Park KK, et al. Straight tapered titanium stem with alumina bearing in cementless primary total hip arthroplasty: a minimum 5-year follow-up. J Arthroplasty, 2011, 26(8): 1310-1317.
20. Scott RD, Sarokhan AJ, Dalziel R. Total hip and total knee arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res, 1984, (182): 90-98.
21. Bangjian H, Peijian T, Ju L. Bilateral synchronous total hip arthroplasty for ankylosed hips. Int Orthop, 2012, 36(4): 697-701.
22. Kim YL, Shin SI, Nam KW, et al. Total hip arthroplasty for bilaterally ankylosed hips. J Arthroplasty, 2007, 22(7): 1037-1041.
23. Kilgus DJ, Namba RS, Gorek JE, et al. Total hip replacement for patients who have ankylosing spondylitis. The importance of the formation of heterotopic bone and of the durability of fixation of cemented components. J Bone Joint Surg (Am), 1990, 72(6): 834-839.
24. Walker LG, Sledge CB. Total hip arthroplasty in ankylosing spondylitis. Clin Orthop Relat Res, 1991, (262): 198-204.
25. 崔旭, 張伯勛, 李靜東. 人工全髖關節置換術治療56例強直性脊柱炎的臨床研究. 中國矯形外科雜志, 2006, 14(9): 666-668.

《中國修復重建外科雜志》

雙錐度生物固定型股骨柄治療髖關節骨性融合的療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國修復重建外科雜志》

雙錐度生物固定型股骨柄治療髖關節骨性融合的療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料