| S-ROM股骨假体在髋关节翻修中应用的临床研究 |
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Received:January 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 朴尚 |
PIAO Shang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 周勇刚 |
ZHOU Yong-gang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
zhouyg@263.net |
| 杜银桥 |
DU Yin-qiao |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 马海洋 |
MA Hai-yang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 孙菁阳 |
SUN Jing-yang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 高志森 |
GAO Zhi-sen |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 彭亚文 |
PENG Ya-wen |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 吴文明 |
WU Wen-ming |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 期刊信息：《中国骨伤》2017年30卷，第4期，第322-328页 |
| DOI：10.3969/j.issn.1003-0034.2017.04.008 |
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目的：探讨在髋关节翻修中使用S-ROM股骨假体重建股骨的中期临床效果。
方法：回顾性分析2008年1月至2016年1月在髋关节翻修术中应用S-ROM假体进行股骨重建的患者21例21髋，男5例，女16例；年龄29~73岁，平均48.33岁。股骨翻修原因：无菌性松动13例，假体周围感染占位器植入术后4例，粗隆下截骨处骨不连2例，反复脱位1例，外伤致大粗隆骨折1例。初次关节置换原因：先天性髋关节发育不良12例（其中Crowe Ⅳ型9例），股骨颈骨折5例，股骨头坏死2例，感染致股骨近端畸形2例。Paprosky股骨缺损分型：Ⅱ型11例，Ⅲa型9例，Ⅲb型1例。比较患者术前及末次随访时Harris髋关节评分及疼痛评分、髋关节屈曲度，记录患者术后末次随访时主观满意度。
结果：手术时间125~290 min，平均189 min。术中出血量200~2 000 ml，平均867 ml。随访时间12~97个月，平均53.14个月。疼痛评分由术前17.14±9.56提高至末次随访的41.71±2.03（t=11.42，P=0.00）；功能评分由术前24.01±11.02提高至末次随访的49.95±5.38（t=9.73，P=0.00）；Harris髋关节评分由术前41.15±14.81提高至末次随访的91.67±5.83（t=15.33，P=0.00）。髋关节屈曲度由术前（93.10±27.27）°提高至末次随访的（121.90±16.62）°（t=4.59，P=0.00）。患者平均主观满意度9.48分（10分制），其中14例完全满意。末次随访X线片显示21例均为骨长入，其他股骨柄无明显松动或下沉。股骨近端袖套有5例周围形成骨锚定征。股骨近端术中骨折5例，3例为小粗隆骨折，2例为大粗隆骨折。因股骨髓腔狭窄，为预防假体植入发生骨折，小粗隆预捆扎钢丝4例。1例因外伤导致股骨假体远端斜行骨折，行切开复位锁定钢板内固定。其他患者无神经损伤、关节脱位、感染及下肢深静脉血栓形成等并发症发生。
结论：S-ROM假体在PaproskyⅡ、Ⅲ型股骨缺损的髋关节翻修术中取得令人满意的结果，特别对于Crowe Ⅳ型先天性髋发育不良等股骨近端畸形的翻修患者可以获得良好初始稳定性，减少并发症，实现远期生物固定。 |
| [关键词]:关节成形术,置换,髋 股骨 再手术 S-ROM假体 |
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| Clinical results in early and mid term of using the S-ROM femoral stem in revision |
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Abstract:
Objective: To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.
Methods: From January 2008 to January 2016,21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range,29 to 73 years old). There were 13 cases caused by aseptic loosening,4 cases by infection,2 cases by nonunion of sub-tuberosity osteotomy,1 case for repeated dislocation,1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe Ⅳ),5 cases for femoral neck fracture,2 cases for necrosis of femoral head,2 cases for proximal femoral deformity caused by early infection. The femur bone defects included PaproskyⅡin 11 cases,Ⅲa in 9,and Ⅲb in 1. Harris hip score,pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up.
Results: The operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup,the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (t=11.42,P=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (t=9.73,P=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(t=15.33,P=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (t=4.59,P=0.00). The mean subjective satisfaction was 9.48(10 points system),14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth,and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture,3 cases of lesser trochanter fracture,2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis,there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture,open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury,dislocation,infection and lower limb deep vein thrombosis and other complications at the final follow-up.
Conclusions: S-ROM prosthesis has satisfactory results in hip revision arthroplasty with PaproskyⅡ and Ⅲ femoral defects. Especially for patients with Crowe Ⅳ DDH and other proximal femoral deformities,it is possible to adapt to the medullary cavity morphology. Excellent initial stability,less complications and long-term biological fixation can be achieved with S-ROM in femur revision. |
| KEYWORDS:Arthroplasty, replacement, hip Femur Reoperation S-ROM stem |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朴尚,周勇刚,杜银桥,马海洋,孙菁阳,高志森,彭亚文,吴文明.S-ROM股骨假体在髋关节翻修中应用的临床研究[J].中国骨伤,2017,30(4):322~328 |
| 英文格式: | PIAO Shang,ZHOU Yong-gang,DU Yin-qiao,MA Hai-yang,SUN Jing-yang,GAO Zhi-sen,PENG Ya-wen,WU Wen-ming.Clinical results in early and mid term of using the S-ROM femoral stem in revision[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(4):322~328 |
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