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》

作者：

李明清 , 胡懿郃 , 李康華 , 廖前德 , 文霆 , 鐘達

中南大學湘雅醫院骨科（長沙，410008）;

關鍵詞：

人工全髖關節置換保留股骨頸型假體中期療效

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【摘要】目的探討保留股骨頸（collum femoris preserving，CFP）型人工全髖關節置換（total hip arthroplasty，THA）的中期療效。方法 2004年1 月－2007年2月，對45例髖關節疾病患者行CFP型THA。男29例（31髖），女16例（17髖）；年齡38～60歲，平均48.8歲。左側20髖，右側22髖，雙側3髖。其中骨關節炎20例，股骨頭缺血性壞死13例，髖關節發育不良致創傷性關節炎4例，類風濕性關節炎3例，髖臼骨折后創傷性關節炎2例，強直性脊柱炎患者2例，Perths病1例。病程2～13年，平均 6.1年。手術前后攝X線片，行Harris評分及疼痛視覺模擬評分（VAS），測量關節活動度；術后評估患者步態，應用SF-36簡明健康狀況調查量表對患者生活質量進行評估。結果45例均獲隨訪，隨訪時間5～8年，平均6.4年。術后切口均Ⅰ期愈合，無感染、髖關節脫位、神經損傷及深靜脈血栓形成等并發癥發生。6例（13.3%）患者術中發生假體遠端股骨外側皮質劈裂骨折，未作特殊處理，均于術后8個月骨折愈合。4例（8.9%）患者出現輕度異位骨化，無特殊不適；5例（11.1%）發生股骨近端骨密度降低。末次隨訪時臼杯和假體柄生存率均為100%。術后1年及末次隨訪時髖關節Harris評分、VAS評分、關節活動度均顯著優于術前（P lt; 0.05）；術后1年與末次隨訪時比較除Harris評分差異有統計學意義（P lt; 0.05）外，其余各指標比較差異均無統計學意義（P gt; 0.05）。末次隨訪時Harris功能評價獲優31髖、良11髖、中6髖，優良率達87.5%。末次隨訪時SF-36評分結果除了生理職能、軀體疼痛和總體健康得分較四川省城市男性的參考值低（P lt; 0.05）外，其余各項得分與參考值比較差異均無統計學意義（P gt; 0.05）。結論CFP型THA中期療效滿意，是股骨頸完整、無骨質疏松年輕患者行THA的一種良好選擇。

引用本文： 李明清,胡懿郃,李康華,廖前德,文霆,鐘達. 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. doi: 復制

1.	Pipino F, Molfetta L. Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol, 1993, 19(1): 5-12.
2.	Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int, 2010, 20 (Suppl 7): 52-57.
3.	Briem D, Schneider M, Bogner N, et al. Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop, 2011, 35(5): 655-660.
4.	Nowak M, Nowak TE, Schmidt R, et al. Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up. Arch Orthop Trauma Surg, 2011, 131(4): 549-555.
5.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
6.	李寧秀, 劉朝杰, 李俊, 等. 四川省城鄉居民SF-36評價參考值. 華西醫科大學學報, 2001, 32(1): 43-47.
7.	Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Results of 3, 668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5): 521-529.
8.	Kinov P, Radl R, Zacherl M, et al. Correlation between thigh pain and radiological findings with a proximally porous-coated stem. Acta Orthop Belg, 2007, 73(5): 618-624.
9.	Callary SA, Campbell DG, Mercer GE, et al. The 6-year migration characteristics of a hydroxyapatite-coated femoral stem a radiostereometric analysis study. J Arthroplasty, 2012, 27(7): 1344-1348.
10.	Chambers B, St Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty, 2007, 22(4 Suppl 1): 71-74.
11.	Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
12.	Gillies RM, Kohan L, Cordingley R. Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement. Comput Methods Biomech Biomed Engin, 2007, 10(2): 97- 102.
13.	Hayashi S, Nishiyama T, Fujishiro T, et al. Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity. Int Orthop, 2012, 36(6): 1137-1142.
14.	Davidson D, Pike J, Garbuz D, et al. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg (Am), 2008, 90(9): 2000-2012.
15.	Thomsen MN, Jakubowitz E, Seeger JB, et al. Fracture load for periprosthetic femoral fractures in cemented versus uncemented hip stems: an experimental in vitro study. Orthopedics, 2008, 31(7): 653.
16.	Jakubowitz E, Seeger JB, Lee C, et al. Do short-stemmed- prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg, 2009, 129(6): 849-855.
17.	Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty, 2009, 24(2): 256-262.
18.	Ritter MA, Galley M. Heterotopic bone formation following resurfacing total hip arthroplasty. HSS J, 2011, 7(1): 41-43.

1. Pipino F, Molfetta L. Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol, 1993, 19(1): 5-12.
2. Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int, 2010, 20 (Suppl 7): 52-57.
3. Briem D, Schneider M, Bogner N, et al. Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop, 2011, 35(5): 655-660.
4. Nowak M, Nowak TE, Schmidt R, et al. Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up. Arch Orthop Trauma Surg, 2011, 131(4): 549-555.
5. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
6. 李寧秀, 劉朝杰, 李俊, 等. 四川省城鄉居民SF-36評價參考值. 華西醫科大學學報, 2001, 32(1): 43-47.
7. Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Results of 3, 668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5): 521-529.
8. Kinov P, Radl R, Zacherl M, et al. Correlation between thigh pain and radiological findings with a proximally porous-coated stem. Acta Orthop Belg, 2007, 73(5): 618-624.
9. Callary SA, Campbell DG, Mercer GE, et al. The 6-year migration characteristics of a hydroxyapatite-coated femoral stem a radiostereometric analysis study. J Arthroplasty, 2012, 27(7): 1344-1348.
10. Chambers B, St Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty, 2007, 22(4 Suppl 1): 71-74.
11. Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
12. Gillies RM, Kohan L, Cordingley R. Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement. Comput Methods Biomech Biomed Engin, 2007, 10(2): 97- 102.
13. Hayashi S, Nishiyama T, Fujishiro T, et al. Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity. Int Orthop, 2012, 36(6): 1137-1142.
14. Davidson D, Pike J, Garbuz D, et al. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg (Am), 2008, 90(9): 2000-2012.
15. Thomsen MN, Jakubowitz E, Seeger JB, et al. Fracture load for periprosthetic femoral fractures in cemented versus uncemented hip stems: an experimental in vitro study. Orthopedics, 2008, 31(7): 653.
16. Jakubowitz E, Seeger JB, Lee C, et al. Do short-stemmed- prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg, 2009, 129(6): 849-855.
17. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty, 2009, 24(2): 256-262.
18. Ritter MA, Galley M. Heterotopic bone formation following resurfacing total hip arthroplasty. HSS J, 2011, 7(1): 41-43.

《中國修復重建外科雜志》

保留股骨頸型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》

保留股骨頸型人工全髖關節置換的中期療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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