一期双侧Tri-lock柄THA治疗强直性脊柱炎髋关节强直
周胜虎;王欢;李旭升;刘军;张浩强;乔永杰;许瑞岭;甄平;张勇;
摘要(Abstract):
[目的]探讨一期Tri-Lock骨保留型股骨柄假体全髋关节置换术(total hip arthroplasty, THA)治疗强直性脊柱炎(ankylosing spondylitis, AS)累及双侧髋关节骨性强直的临床疗效。[方法]本院关节外科于2010年12~2018年12月治疗一期采用Tri-lock柄行THA的12例(24髋)强直性脊柱炎累及双侧髋关节骨性强直患者,其中男9例,女3例;年龄19~37岁,平均(28.32±6.43)岁。病程6~21年,平均(12.30±3.50)年。术中股骨颈均采用二次截骨,术后骨盆正位及双侧髋关节侧位X线片,评价人工髋关节假体位置,Engh标准评价骨-假体界面稳定性,Harris评分标准评价髋关节功能。[结果]均获随访13个月~7年,平均(5.60±2.20)年。术后12例(24髋) Harris评分(91.50±3.10)分,与术前相比,差异有统计学意义(P<0.05)。术后1例发生坐骨神经麻痹,经屈髋屈膝位对症处理后治愈,其余患者均无骨折、血管神经损伤、髋关节脱位、感染、假体松动、深静脉血栓、肺部感染等并发症发生。[结论]一期Tri-Lock骨保留型股骨柄假体THA治疗强直性脊柱炎累及双侧髋关节强直,可有效改善双侧髋关节活动度,重建髋关节功能,提高患者生活质量。
关键词(KeyWords): 强直性脊柱炎;髋关节骨性强直;Tri-lock柄;人工全髋关节置换术
基金项目(Foundation): 全军后勤科研计划面上项目(编号:CWH17J009);; 全军医学科技青年培育计划项目(编号:19QNP047);; 甘肃省自然科学基金项目(编号:18JR3RA409);; 甘肃省卫生行业科研计划项目(编号:GSWSKY2018-21);; 兰州市人才创新创业项目(编号:2019-RC-65)
作者(Author): 周胜虎;王欢;李旭升;刘军;张浩强;乔永杰;许瑞岭;甄平;张勇;
Email:
DOI:
参考文献(References):
- [1]姜炜.强直性脊柱炎致髋关节强直患者骨盆倾斜角与髋臼、股骨颈前倾角的相关性分析[D].西安:第四军医大学, 2014.
- [2]甄平,李旭升,周胜虎,等.生物型短柄假体在年轻患者Dorr C型股骨髓腔全髋关节置换中的应用[J].中国矫形外科杂志,2018, 26(3):193-197.
- [3]魏召劝,孙俊英,查国春,等.采用高交联聚乙烯与传统聚乙烯髋臼内衬行人工全髋关节置换的比较研究[J].中国修复重建外科杂志, 2013, 27(12):1414-1418.
- [4] Noordin S, Waters TS, Garbuz DS, et al. Tranexamic acid reduces allogenic transfugion inrevision hip arthroplasty[J]. Clin Orthop,2011, 469(2):541-546.
- [5] Teloken MA, Bissett G, Hozack WJ, et al. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt–chromium femoral component(tri-lock)inserted without cement[J]. J Bone Joint Surg Am, 2002, 84(12):2140-2144.
- [6] Mulliken BI, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty:radiographic evaluation and stability[J]. J Bone Joint Surg Am,1996, 78(8):1214-1225.
- [7] Murray DW. The definition and measurement of acetabularorientation[J]. J Bone Joint Surg Br, 1993, 75(2):228-232.
- [8] Woo RY, Morrey BF. Dislocations aft er totalhip arthroplasty[J]. J Bone Joint Surg Am, 1982, 64(9):1295-1306.
- [9] Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty[J]. J Bone Joint Surg Am, 2001, 83-A(9):1333-1338.
- [10] Engh CA Jr, Culpepper WJ, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty[J]. J Bone Joint Surg Am, 1997, 79(2):177-184.
- [11] DeLee JG, Charnley J. Radiological demarcation ofcemented sockets in total hip replacement[J]. Clin Orthop, 1976, 121(121):20-32.
- [12] Gruen TA, McNeice GM, Amstutz HC.“Modes of failure”ofcemented stem-type femoral components:a radiographic analysis ofloosening[J]. Clin Orthop, 1979, 141(141):17-27.
- [13] D'Antonio JA, Capello WN, Manley MT. Remodeling of bonearound hydroxyapatite-coated femoral stems[J]. J Bone Joint Surg Am, 1996, 78(8):1226-1234.
- [14] Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end-resultstudy using a new method of result evaluation[J]. J Bone Joint Surg(Am), 1969, 51(4):737-755.
- [15] Jeong H, Eun YH, Kim IY, et al. Characteristics of hipinvolvement in patients with ankylosing spondylitis in Korea[J]. Korean J Intern Med, 2016, 29(4):297-305.
- [16] Bangjian H, Peijian T, Ju L. Bilateral synchronous totalhip arthroplasty for ankylosed hips[J]. Int Orthop, 2012, 36(4):697-701.
- [17] Falez F, Casella F, Panegrossi G, et al. Perspectives on metaphyseal conservative stems[J]. J Orthop Traumatol, 2008, 9(1):49-54.
- [18] Khanuja HS, Banerjee S, Jain D, et al. Short bone-conserving stems in cementless hip arthroplasty[J]. J Bone Joint Surg Am,2014, 96(20):1742-1752.
- [19]刘军,甄平,周胜虎,等.骨保留型股骨柄假体在全髋关节置换中的临床应用[J].中国骨伤, 2018, 31(2):129-134.