短柄全髋关节置换术治疗股骨头坏死患者的疗效分析

摘要

AIM:To evaluate the clinical effects of short stem ceramic-on-ceramic total hip arthroplasty in the treatment of pa-tients with femoral head necrosis.METHODS:From June 2009 to December 2012,38 patients with femoral head necrosis were treated primarily with short stem ceramic-on-ceramic hip arthro-plasty (40 hips)through posterior-lateral or anterior-lateral ap-proach.There were 23 males and 15 females,with the mean age of (32.6 ±18.2)years old.All cases were stage IV or more ac-cording to Steinberg stage.The patients were followed up at right after operation,the 6,12 months after operation and then once each year.Standard X-ray films were taken at the follow ups. Femoral pmsthesis subsidence was assessed through X ray films. Harris scores system and WOMAC Osteoarthtitis Index were recor-ded before and after operation to evaluate clinical effects of surger-y.RESULTS:Thirty-six patients (38 hips)were followed up for about 32.4 months.The femoral stem subsided (0.71 ±2.88) mm at the last follow up.After operation,hip pain of patients was relieved obviously.The Harris score improved from (37.9 ± 11.9)preoperatively to (95.6 ±4.8 )postoperatively,while WOMAC Index from (67.1 ±11.9)to (12.7 ±5.8).CON-CLUSION:The short stem hip arthroplasty preserves bone stock to a great extent.The short stem implant showed a good stability and osseous integration.The weal rate of cemmic-on-ceramic beating surface is extremely low.Short stem hip arthroplasty plus ceramic-on-ceramic beating surface might be a good option for the patients with femoral head necrosis.%目的：评价短柄全髋关节置换术对股骨头坏死的治疗效果．方法：从我院选择2009-06／2012-12接受陶瓷对陶瓷短柄全髋关节置换术治疗的股骨头坏死的患者38例（40髋），其中男性23例，女性15例，平均年龄32．6±18．2岁，并且 Steinberg 分期均为 IV 期以上．21例从后外侧入路，17例采用前外侧入路，术后即刻、6个月、12个月以及随后每年都进行随访，摄骨盆正位以及髋关节侧面 X 线片，测量假体下沉距离，采用 Harris 髋关节评分和 WOMAC 骨关节指数评估关节功能．结果：36例（38髋）患者获得随访，平均随访时间为32．4个月，最后一次随访假体较术后下沉（0．71±2．88）mm，差异无统计学意义（P ＞0．05）．术后髋关节疼痛均明显改善， Harris 髋关节评分术前为（37．9±11．9）分，末次随访为（95．6±4．8）分，差异有统计学意义（P ＜0．05），WOMAC 骨关节指数术前为（67．1±11．9），末次随访为（12．7±5．8），差异有统计学意义（P ＜0．05）．结论：短柄全髋关节置换术能够更多地保留骨量，假体初始稳定性好，全陶瓷头衬配伍的磨损率低，疗效佳，相关并发症少．