双锥度生物固定型股骨柄治疗髋关节骨性融合的疗效_《中国修复重建外科杂志》

作者：

张强 , 刘明 , 柴伟 , 张国强 , 陈继营 , 李众利 , 董晓艳 , 周勇刚 , 王秀丽 , 王岩

解放军总医院骨科（北京，100853）;

关键词：

人工全髋关节置换术骨性融合双锥度生物固定型股骨柄

DOI：

10.7507/1002-1892.20130064

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的通过与解剖型股骨柄比较，探讨对髋关节骨性融合患者采用双锥度生物固定型股骨柄行人工全髋关节置换的疗效。方法回顾分析1999年10月－2008年1月采用人工全髋关节置换治疗的50例80髋髋关节骨性融合患者临床资料，其中31例49髋采用BetaCone双锥度生物固定型股骨柄（试验组），19例31髋采用Ribbed解剖型股骨柄（对照组）。两组患者性别、年龄、病程、术前Harris评分及关节外展角度比较，差异均无统计学意义（P gt; 0.05），具有可比性。术后X线片上测量两组外展肌力臂（a）、重力臂（b），计算其比值，并分析假体稳定性；随访测量关节外展角度，行Harris评分。结果术中9例9髋（试验组5例、对照组4例）发生骨折，经固定后骨折均愈合，假体稳定。术后患者均获随访，其中试验组随访时间12～98个月，平均49个月；对照组6～105个月，平均53个月。X线片复查示试验组a/b为0.65 ± 0.25，对照组为0.56 ± 0.37，差异有统计学意义（t=2.19，P=0.03）；末次随访时假体位置稳定。术后6个月，试验组关节外展角度为（34.49 ± 7.58）°，对照组为（30.97 ± 7.24）°，均较术前显著改善（P lt; 0.05），组间比较差异亦有统计学意义（t=2.06，P=0.04）。术后两组Harris评分均较术前显著提高（P lt; 0.05），术后1个月试验组评分优于对照组（t=3.62，P=0.01），但末次随访时两组间差异无统计学意义（t=1.61，P=0.11）。术后2年试验组12例14髋、对照组8例9髋发生1～2 级异位骨化。结论对于髋关节骨性融合患者，采用解剖型股骨柄及双锥度生物固定型股骨柄行人工全髋关节置换均可获得满意疗效，但双锥度生物固定型股骨柄置换术后早期具有更好的关节外展功能。

引用本文： 张强,刘明,柴伟,张国强,陈继营,李众利,董晓艳,周勇刚,王秀丽,王岩. 双锥度生物固定型股骨柄治疗髋关节骨性融合的疗效. 中国修复重建外科杂志, 2013, 27(3): 278-282. doi: 10.7507/1002-1892.20130064 复制

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, 李康华, 等. 保留股骨颈型人工全髋关节置换的中期疗效. 中国修复重建外科杂志, 2012, 26(8): 897-901.
6.	闵重函, 周瑛, 张洪美. 全髋关节置换术治疗非功能位髋关节骨性强直12例17髋. 中国骨伤, 2011, 24(3): 231-235.
7.	宋立明, 于建华, 张铁良. 人工全髋关节置换术治疗强直性脊柱炎髋关节屈曲强直的临床疗效. 中国修复重建外科杂志, 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, 张伯勋, 李静东. 人工全髋关节置换术治疗56例强直性脊柱炎的临床研究. 中国矫形外科杂志, 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, 李康华, 等. 保留股骨颈型人工全髋关节置换的中期疗效. 中国修复重建外科杂志, 2012, 26(8): 897-901.
6. 闵重函, 周瑛, 张洪美. 全髋关节置换术治疗非功能位髋关节骨性强直12例17髋. 中国骨伤, 2011, 24(3): 231-235.
7. 宋立明, 于建华, 张铁良. 人工全髋关节置换术治疗强直性脊柱炎髋关节屈曲强直的临床疗效. 中国修复重建外科杂志, 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, 张伯勋, 李静东. 人工全髋关节置换术治疗56例强直性脊柱炎的临床研究. 中国矫形外科杂志, 2006, 14(9): 666-668.

《中国修复重建外科杂志》

双锥度生物固定型股骨柄治疗髋关节骨性融合的疗效

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

双锥度生物固定型股骨柄治疗髋关节骨性融合的疗效

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料