生物型全髋关节置换术联合打压植骨治疗类风湿关节炎继发中重度髋臼内陷 |
Hits: 11
Download times: 1
Received:August 10, 2023
|
作者 | Author | 单位 | Unit | E-Mail |
刘鹏 |
LIU Peng |
联勤保障部队第940医院关节外科, 甘肃 兰州 730050 |
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China |
|
宋晓阳 |
SONG Xiao-yang |
联勤保障部队第940医院关节外科, 甘肃 兰州 730050 |
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China |
|
常彦峰 |
CHANG Yan-feng |
联勤保障部队第940医院关节外科, 甘肃 兰州 730050 |
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China |
|
甄平 |
ZHEN Ping |
联勤保障部队第940医院关节外科, 甘肃 兰州 730050 |
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China |
|
刘军 |
LIU Jun |
西安交通大学附属第二医院 西北医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Northwest Hospital, Xi'an 710004, Shaanxi, China |
|
周胜虎 |
ZHOU Sheng-hu |
联勤保障部队第940医院关节外科, 甘肃 兰州 730050 |
Department of Joint Surgery, the 940th Hospital of PLA Joint Logistics Support Force, Lanzhou 730050, Gansu, China |
zhoushenghu120@163.com |
|
期刊信息:《中国骨伤》2024年37卷,第11期,第1087-1095页 |
DOI:10.12200/j.issn.1003-0034.20230068 |
基金项目:甘肃省重点研发计划(编号:21YF5FA154);甘肃省青年科技基金(编号:20JR5RA588,21JR7RA014);甘肃省自然科学基金(编号:22JR5RA009);陕西省自然科学基础研究项目(编号:2022JM-554);兰州市科技计划项目(编号:2023-2-11,2023-2-28);第九零四医院院内科研基金项目(编号:2023YXKY014,2023YXKY036) |
|
目的: 探讨生物型全髋关节置换术(total hip arthroplasty,THA)联合打压植骨治疗类风湿关节炎(rheumatoid arthritis,RA)继发髋臼内陷症的手术技巧及临床疗效。
方法: 自2012年1月至2020年10月,采用生物型假体行人工全髋关节置换术治疗20例(28髋) RA继发髋臼内陷患者,男5例(8髋),女15例(20髋),年龄45~64(55.10±4.96)岁。术前髋臼内陷深度8.43~16.29(11.91±2.59) mm。根据Sotello-Garza和Charnley分型:Ⅱ 型(内陷6~15 mm)15例(23髋)、Ⅲ型(内陷>15 mm)5例(5髋)。术中采用自体股骨头颗粒骨和(或)同种异体骨打压植骨重建髋臼,采用压配方式固定生物型多孔髋臼杯。术后随访评估髋关节的活动功能、双下肢长度差、视觉模拟评分(visual analogue scale,VAS)及Harris评分;X线片评估植骨愈合情况、髋臼旋转中心恢复情况及假体松动情况。
结果: 20例获随访,时间2~10(5.45±2.50)年。手术时间75~160(103.32±18.18) min;术中出血量150~650(319.64±122.61) ml。术中均未发生神经血管及其他并发症。末次随访时,髋关节旋转中心的水平移位由术前(11.40±1.85) mm增加到(25.99±2.56) mm(P<0.01);髋关节旋转中心的垂直移位由术前(89.36±5.20) mm增加到(71.84±3.55) mm(P<0.01);髋关节屈伸活动度由术前(44.43±10.57)°增加到(98.75±12.52)°(P<0.01);髋关节的外展活动度由术前(12.50±6.01)°增加到(32.82±5.39)°(P<0.01);双下肢长度差由术前(19.39±5.93) mm减少到(6.64±2.87) mm(P<0.01);VAS由术前(5.36±0.78)分降低到(1.82±0.86)分(P<0.01);Harris评分由术前(41.39±7.77)分增加到(89.00±4.67)分(P<0.01)。末次随访的患者均可在不借助辅助下自主活动。其中,2例(2髋)患者活动后髋部疼痛不适,1例(1髋)因摔倒致假体周围骨折。
结论: 采用自体股骨头颗粒植骨重建髋臼,恢复髋关节旋转中心,联合生物型多孔钽/钛金属髋臼杯治疗RA继发髋臼内陷取得良好的近中期疗效。 |
[关键词]:全髋关节置换术 类风湿关节炎 髋臼内陷 骨移植 生物型假体 |
|
Biological total hip arthroplasty combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis |
|
Abstract:
Objective To explore the surgical technique and clinical outcomes of biological total hip arthroplasty(THA) combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis(RA).
Methods Total of 20 patients(28 hips) with RA secondary to acetabular invagination were treated with THA of bioprosthesis combined with autogenous bone grafting from January 2012 to October 2020,including 5 males(8 hips) and 15 females(20 hips) with an average age of (55.10±4.96) years old from 45 to 64 years old. The depth of acetabular invagination was 8.43 to 16.25 mm with an average of (11.91±2.59) mm. According to Sotello-Garza and Charnley classification criterion,there were 15 cases(23 hips) of type Ⅱ(protrusio acetabuli 6 to 15 mm),and 5 cases(5 hips) of type Ⅲ(protrusio acetabuli>15 mm). Autologous femoral head granular bone and(or) allograft impacting grafting were used to reconstruct the acetabum,the biological porous acetabular cup was fixed by pressure fitting. At the postoperative follow-up,the activity function of the hip joint,the length of both lower limbs,VAS and Harris score were evaluated,and the healing of bone graft,the restoration of the hip rotation center and loosening of prosthesis were assessed by X-ray.
Results The operation time was 75 to 160 min with anverage of (103.32±18.18) min,the intraoperative blood loss was 150 to 650 ml with an average of (319.64±122.61) ml. There were no neurovascular complications during the operation. All patients were followed up from 2 to 10 years with an average of (5.45±2.50) years. The horizontal distance between the center of femoral head and the Kohler's line was increased from (11.40±1.85) mm preoperatively to (25.99±2.56) mm at the final follow-up(P<0.01),and the vertical distance between the center of femoral head and the line joining bilateral ischial tuberosities was decreased from (89.36±5.20) mm preoperatively to (71.84±3.55) mm at the final follow-up(P<0.01). The range of flexion motion of hip joint increased from (44.43±10.57)° preoperatively to (98.75±12.52)° at the final follow-up(P<0.01),the range of abduction motion of hip joint increased from (12.50 ±6.01)°preoperatively to final follow-up (32.82±5.39)°(P<0.01). The discrepancy of both lower limbs was significantly decreased from (19.39±5.93) mm preoperatively to (6.64±2.87) mm at the final follow-up(P<0.01). The VAS decreased from (5.36±0.78) preoperatively to (1.82±0.86) at the final follow-up(P<0.05),and the Harris score increased from (41.39±7.77) preoperatively to (89.00±4.67) at the final follow-up(P<0.01). All the patients could move independently without assistance. Among them,2 patients(2 hips) had hip pain after exercise,and 1 patient(1 hip) suffered from periprosthetic fracture due to fall.
Conclusion Autologous femoral head granular bone grafting can reconstruct the acetabulum,and restore the rotation center of the hip joint,combined with biological porous tantalum/titanium acetabular cup can achieve good short-and medium-term outcomes in the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis. |
KEYWORDS:Total hip arthroplasty Rheumatoid arthritis Acetabular invagination Bone grafting Biological prosthesis |
|
引用本文,请按以下格式著录参考文献: |
中文格式: | 刘鹏,宋晓阳,常彦峰,甄平,刘军,周胜虎.生物型全髋关节置换术联合打压植骨治疗类风湿关节炎继发中重度髋臼内陷[J].中国骨伤,2024,37(11):1087~1095 |
英文格式: | LIU Peng,SONG Xiao-yang,CHANG Yan-feng,ZHEN Ping,LIU Jun,ZHOU Sheng-hu.Biological total hip arthroplasty combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(11):1087~1095 |
|
View Full Text View/Add Comment Download reader |
Close |
|
|
|