應用矩形截面錐形股骨假體行人工全髖關節置換的中期療效_《中國修復重建外科雜志》

作者：

劉宏偉 ^1,2 , 顧衛東 ¹ , 孫俊英 ²

1南京醫科大學附屬常州第二人民醫院骨科（江蘇常州，213000）;;
2蘇州大學附屬第一醫院骨科;

關鍵詞：

人工全髖關節置換矩形截面錐形股骨假體中期療效

DOI：

10.7507/1002-1892.20130131

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目的探討應用矩形截面錐形股骨假體行人工全髖關節置換術后的中期療效。方法2004年5月－2006年6月，對58例61髖髖關節疾患患者采用矩形截面錐形股骨假體行人工全髖關節置換，回顧分析獲6年以上隨訪的43例45髖患者臨床資料。男21例23髖，女22例22髖；年齡25～75歲，平均51.6歲。單髖置換41例，雙髖置換2例。先天性髖關節發育不良12例12髖，髖臼發育不良伴骨性關節炎1例1髖，小兒麻痹癥后遺髖關節畸形1例1髖，股骨頸骨折9例9髖，股骨頭缺血性壞死8例8髖，髖關節骨性關節炎8例8髖，類風濕性關節炎2例3髖，強直性脊柱炎累及髖關節2例3髖。術前髖關節Harris評分為（41.7 ± 10.4）分。術后行X線片檢查，分析股骨假體位置，評價骨-假體界面穩定性；應用Harris評分標準評價髖關節功能。結果術中發生假體周圍骨折3髖，術后大腿痛4髖。患者均獲隨訪，隨訪時間74～99個月，平均85個月。末次隨訪時髖關節Harris評分為（87.6 ± 8.3）分，與術前比較差異有統計學意義（t=23.14，P=0.00）。X線片檢查示，術后發生異位骨化9髖，不同程度股骨近端應力遮擋性骨吸收42髖；骨-假體界面穩定，無感染、脫位及無菌性松動翻修發生，股骨假體生存率達100%。結論采用矩形截面錐形股骨假體行人工全髖關節置換中期療效滿意。

引用本文： 劉宏偉,顧衛東,孫俊英. 應用矩形截面錐形股骨假體行人工全髖關節置換的中期療效. 中國修復重建外科雜志, 2013, 27(5): 594-598. doi: 10.7507/1002-1892.20130131 復制

1.	Poss R, Walker P, Spector M, et al. Strategies for improving fixation of femoral components in total hip arthroplasty. Clin Orthop Relat Res, 1988, (235): 181-194.
2.	Nakamura Y, Mitusui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
3.	Kim YH, Park JW, Kim JS. Is diaphyseal stem fixation necessary for primary total hip arthroplasty in patients with osteoporotic bone (Class C bone)? J Arthroplasty, 2013, 28(1): 139-146. e1.
4.	朱力波, 馬金忠, 王建東, 等. C2非骨水泥股骨柄在人工髖關節置換中的應用. 中國臨床醫學, 2007, 14(2): 231-232.
5.	馬金忠, 俞銀賢, 朱力波, 等. 生物固定C2型股骨柄對股骨近端應力遮擋影響的臨床研究. 中華關節外科雜志(電子版), 2008, 2(5): 516-520.
6.	Engh CA, McGovern TF, Bobyn DJ, et al. A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg (Am), 1992, 74-A(7): 1009-1012.
7.	Goetz DD, Smith EJ, Harris WH. The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacement. A retrospective matched-pair series. J Bone Joint Surg (Am), 1994, 72(8): 1121-1129.
8.	Engh CA Jr, McAuley JP, Sychterz CJ, et al. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg (Am), 2000, 82-A(10): 1414-1420.
9.	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.
10.	Lavernia C, D’Apuzzo M, Hernandez V, et al. Thigh pain in primary total hip arthroplasty: the effects of elastic moduli. J Arthroplasty, 2004, 19(7 Suppl 2): 10-16.
11.	毛賓堯, 李新春, 王毳, 等. 解剖型羥基磷灰石噴涂Ribbed股骨柄和臼杯全髖關節置換術患者的8年隨訪觀察. 中華關節外科雜志(電子版), 2010, 4(4): 494-499.
12.	Danesh-Clough T, Bourne RB, Rorabeck CH, et al. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty, 2007, 22(2): 195-203.
13.	Korovessis P, Repantis T, Zafiropoulos A. High medium-term survivorship and durability of Zweymüller-Plus total hip arthroplasty. Arch Orthop Trauma Surg, 2011, 131(5): 603-611.
14.	Weissinger M, Helmreich C, Pöll G. Results covering 20 years use of the cement-free Zweymüller Alloclassic total endoprosthesis of the hip joint. Acta Chir Orthop Traumatol Cech, 2010, 77(3): 186-193.
15.	唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
16.	賈世孔, 肖晟, 張寅龍. BetaCone雙錐度生物固定型髖關節柄在嚴重骨質疏松全髖關節置換中的早期應用. 中國組織工程研究與臨床康復, 2008, 12(30): 5801-5804.
17.	Boyle C, Kim IY. Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization. J Biomech, 2011, 44(9): 1722-1728.
18.	Karachalios T, Tsalsaronis C, Efraimis G, et al. The long-term clinical relevance atrophy caused by stress shielding in total hip arthroplasty: a 10-year, prospective, randomized study. J Arthroplasty, 2004, 19(4): 469-475.
19.	劉延青, 劉巖, 張克, 等. 非骨水泥近端固定股骨柄和遠端固定股骨柄中期隨訪時骨丟失的X線片表現. 中國修復重建外科雜志, 2007, 21(8): 805-809.
20.	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.

1. Poss R, Walker P, Spector M, et al. Strategies for improving fixation of femoral components in total hip arthroplasty. Clin Orthop Relat Res, 1988, (235): 181-194.
2. Nakamura Y, Mitusui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
3. Kim YH, Park JW, Kim JS. Is diaphyseal stem fixation necessary for primary total hip arthroplasty in patients with osteoporotic bone (Class C bone)? J Arthroplasty, 2013, 28(1): 139-146. e1.
4. 朱力波, 馬金忠, 王建東, 等. C2非骨水泥股骨柄在人工髖關節置換中的應用. 中國臨床醫學, 2007, 14(2): 231-232.
5. 馬金忠, 俞銀賢, 朱力波, 等. 生物固定C2型股骨柄對股骨近端應力遮擋影響的臨床研究. 中華關節外科雜志(電子版), 2008, 2(5): 516-520.
6. Engh CA, McGovern TF, Bobyn DJ, et al. A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg (Am), 1992, 74-A(7): 1009-1012.
7. Goetz DD, Smith EJ, Harris WH. The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacement. A retrospective matched-pair series. J Bone Joint Surg (Am), 1994, 72(8): 1121-1129.
8. Engh CA Jr, McAuley JP, Sychterz CJ, et al. The accuracy and reproducibility of radiographic assessment of stress-shielding. A postmortem analysis. J Bone Joint Surg (Am), 2000, 82-A(10): 1414-1420.
9. 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.
10. Lavernia C, D’Apuzzo M, Hernandez V, et al. Thigh pain in primary total hip arthroplasty: the effects of elastic moduli. J Arthroplasty, 2004, 19(7 Suppl 2): 10-16.
11. 毛賓堯, 李新春, 王毳, 等. 解剖型羥基磷灰石噴涂Ribbed股骨柄和臼杯全髖關節置換術患者的8年隨訪觀察. 中華關節外科雜志(電子版), 2010, 4(4): 494-499.
12. Danesh-Clough T, Bourne RB, Rorabeck CH, et al. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty, 2007, 22(2): 195-203.
13. Korovessis P, Repantis T, Zafiropoulos A. High medium-term survivorship and durability of Zweymüller-Plus total hip arthroplasty. Arch Orthop Trauma Surg, 2011, 131(5): 603-611.
14. Weissinger M, Helmreich C, Pöll G. Results covering 20 years use of the cement-free Zweymüller Alloclassic total endoprosthesis of the hip joint. Acta Chir Orthop Traumatol Cech, 2010, 77(3): 186-193.
15. 唐際存, 王梨明, 胡譯文, 等. 矩形柄人工髖關節置換治療老年股骨轉子間粉碎性骨折. 中國修復重建外科雜志, 2011, 25(11): 1400-1402.
16. 賈世孔, 肖晟, 張寅龍. BetaCone雙錐度生物固定型髖關節柄在嚴重骨質疏松全髖關節置換中的早期應用. 中國組織工程研究與臨床康復, 2008, 12(30): 5801-5804.
17. Boyle C, Kim IY. Comparison of different hip prosthesis shapes considering micro-level bone remodeling and stress-shielding criteria using three-dimensional design space topology optimization. J Biomech, 2011, 44(9): 1722-1728.
18. Karachalios T, Tsalsaronis C, Efraimis G, et al. The long-term clinical relevance atrophy caused by stress shielding in total hip arthroplasty: a 10-year, prospective, randomized study. J Arthroplasty, 2004, 19(4): 469-475.
19. 劉延青, 劉巖, 張克, 等. 非骨水泥近端固定股骨柄和遠端固定股骨柄中期隨訪時骨丟失的X線片表現. 中國修復重建外科雜志, 2007, 21(8): 805-809.
20. 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.

《中國修復重建外科雜志》

應用矩形截面錐形股骨假體行人工全髖關節置換的中期療效

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《中國修復重建外科雜志》

應用矩形截面錐形股骨假體行人工全髖關節置換的中期療效

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