直接前入路髋关节置换术及其早期临床疗效

发布时间：2018-06-03 01:58

本文选题：髋关节 + 关节成形术　；参考：《北京大学学报(医学版)》2017年02期

【摘要】：目的:探讨直接前入路髋关节置换的手术技术和早期临床疗效。方法:对北京积水潭医院矫形骨科2015年3月11日至2016年6月21日,共100例患者116髋(双侧髋关节16例)进行了直接前入路髋关节置换术,其中男性50例,女性50例,平均年龄51岁,平均体重指数24.69 kg/m2。术前诊断包括股骨头缺血坏死、髋关节骨关节炎、髋臼发育不良继发骨关节炎、髋关节陈旧感染、强直性脊柱炎、类风湿性关节炎、股骨颈骨折空心钉术后股骨头坏死等,其中7例髋关节既往有手术史,3例为股骨头坏死既往采用Smith-Peterson入路进行植骨,2例为髋臼发育不良采用Smith-Peterson入路进行髋臼加盖术,2例为股骨颈骨折空心钉内固定(内固定残留)。所有髋关节假体均为非骨水泥型,其中67例股骨柄为Triloc(美国强生公司),45例Corail(美国强生公司),2例Accolade(美国史赛克医疗器械公司),1例Synergy(美国施乐辉公司),1例Polarstem(美国施乐辉公司)。结果:术后平均随访8.5个月,切口瘢痕长度平均10 cm,术后Harris评分平均93.62。95%患者术后双下肢长度差别在3 mm以内。术后平均外展角为38.7°,94.8%髋关节外展角在30°~50°,平均前倾角为14.3°,94.2%髋关节前倾角在5°~25°。共有15例(12.9%)发生术中和术后并发症,2例股骨穿孔(由原计划的Triloc柄改为Corail柄处理),3例股骨矩劈裂(采用钢丝环扎固定),4例大转子骨折(2例采用钢丝张力带固定,2例未移位骨折未处理),1例深部感染(清创处理并保留了假体),1例浅表软组织感染(清创处理),1例血肿和3例伤口愈合不良(清创处理),所有并发症病例至随访时均已痊愈。未见术后脱位和严重血管神经损伤病例,35例(30.2%)髋关节术后出现股外侧皮神经麻痹症状。结论:直接前入路髋关节置换能够更准确地控制髋臼假体安放角度和双下肢肢体长度,降低术后脱位风险,有利于术后早期快速康复。
[Abstract]:Objective: to investigate the surgical technique and early clinical effect of direct anterior approach hip arthroplasty. Methods: from March 11, 2015 to June 21, 2016, 116 hips (16 bilateral hip joints) in the orthopedic department of Beijing Jishui Tan Hospital underwent direct anterior hip replacement, including 50 males and 50 females. The average age was 51 years and the average BMI was 24.69 kg / m2. Preoperative diagnosis included avascular necrosis of femoral head, osteoarthritis of hip joint, osteoarthritis secondary to acetabular dysplasia, old infection of hip joint, ankylosing spondylitis, rheumatoid arthritis, necrosis of femoral head after hollow nail of femoral neck fracture, etc. Among them, 7 cases had a history of previous operation, 3 cases were necrosis of femoral head, 2 cases were treated with Smith-Peterson approach, 2 cases with acetabular dysplasia were treated with Smith-Peterson approach, 2 cases were internal fixation of femoral neck fracture with hollow nail (internal fixation remained). All hip prostheses were of cementless type, of which 67 were of Triloco (45 cases of Corail, Johnson Company) (2 cases of Accolade, Johnson Company of USA, 1 case of Synergy, 1 case of Synergye, 1 case of Polarstem of Schlehui Company, USA). Results: the average postoperative follow-up was 8.5 months, the average length of incision scar was 10 cm, and the average Harris score was 93.62.95%. The difference of the length of lower limbs was less than 3 mm. The average abduction angle was 38.7 掳/ 94.8% and the average antegrade angle was 14.3 掳/ 94.2% and 5 掳/ 25 掳respectively. Intraoperative and postoperative complications occurred in 15 patients with perforation of femur (from planned Triloc handle to Corail handle). 3 cases of femoral moment splitting (4 cases of great trochanteric fracture were fixed by wire ring fixation) 2 cases were fixed with steel wire tension band. One case of deep infection (debridement and preservation of prosthesis) was performed in 1 case of undisplaced fracture and 1 case of superficial soft tissue infection (1 case of hematoma and 3 cases of poor wound healing) (debridement and treatment, all complication cases were cured by follow-up. There were no postoperative dislocation and severe vascular and nerve injury in 35 patients (30.2) the lateral femoral cutaneous nerve palsy was found after hip joint operation. Conclusion: direct anterior approach hip arthroplasty can more accurately control the angle of acetabular prosthesis placement and limb length of both lower extremities, reduce the risk of dislocation after operation, and is beneficial to early and rapid recovery after operation.
【作者单位】：北京积水潭医院矫形骨科;
【分类号】：R687.4

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