本文選題：髖關(guān)節(jié) + 關(guān)節(jié)成形術(shù)　； 參考：《北京大學(xué)學(xué)報(醫(yī)學(xué)版)》2017年02期

【摘要】：目的:探討直接前入路髖關(guān)節(jié)置換的手術(shù)技術(shù)和早期臨床療效。方法:對北京積水潭醫(yī)院矯形骨科2015年3月11日至2016年6月21日,共100例患者116髖(雙側(cè)髖關(guān)節(jié)16例)進(jìn)行了直接前入路髖關(guān)節(jié)置換術(shù),其中男性50例,女性50例,平均年齡51歲,平均體重指數(shù)24.69 kg/m2。術(shù)前診斷包括股骨頭缺血壞死、髖關(guān)節(jié)骨關(guān)節(jié)炎、髖臼發(fā)育不良繼發(fā)骨關(guān)節(jié)炎、髖關(guān)節(jié)陳舊感染、強(qiáng)直性脊柱炎、類風(fēng)濕性關(guān)節(jié)炎、股骨頸骨折空心釘術(shù)后股骨頭壞死等,其中7例髖關(guān)節(jié)既往有手術(shù)史,3例為股骨頭壞死既往采用Smith-Peterson入路進(jìn)行植骨,2例為髖臼發(fā)育不良采用Smith-Peterson入路進(jìn)行髖臼加蓋術(shù),2例為股骨頸骨折空心釘內(nèi)固定(內(nèi)固定殘留)。所有髖關(guān)節(jié)假體均為非骨水泥型,其中67例股骨柄為Triloc(美國強(qiáng)生公司),45例Corail(美國強(qiáng)生公司),2例Accolade(美國史賽克醫(yī)療器械公司),1例Synergy(美國施樂輝公司),1例Polarstem(美國施樂輝公司)。結(jié)果:術(shù)后平均隨訪8.5個月,切口瘢痕長度平均10 cm,術(shù)后Harris評分平均93.62。95%患者術(shù)后雙下肢長度差別在3 mm以內(nèi)。術(shù)后平均外展角為38.7°,94.8%髖關(guān)節(jié)外展角在30°~50°,平均前傾角為14.3°,94.2%髖關(guān)節(jié)前傾角在5°~25°。共有15例(12.9%)發(fā)生術(shù)中和術(shù)后并發(fā)癥,2例股骨穿孔(由原計劃的Triloc柄改為Corail柄處理),3例股骨矩劈裂(采用鋼絲環(huán)扎固定),4例大轉(zhuǎn)子骨折(2例采用鋼絲張力帶固定,2例未移位骨折未處理),1例深部感染(清創(chuàng)處理并保留了假體),1例淺表軟組織感染(清創(chuàng)處理),1例血腫和3例傷口愈合不良(清創(chuàng)處理),所有并發(fā)癥病例至隨訪時均已痊愈。未見術(shù)后脫位和嚴(yán)重血管神經(jīng)損傷病例,35例(30.2%)髖關(guān)節(jié)術(shù)后出現(xiàn)股外側(cè)皮神經(jīng)麻痹癥狀。結(jié)論:直接前入路髖關(guān)節(jié)置換能夠更準(zhǔn)確地控制髖臼假體安放角度和雙下肢肢體長度,降低術(shù)后脫位風(fēng)險,有利于術(shù)后早期快速康復(fù)。
[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 擄/ 94.8% and the average antegrade angle was 14.3 擄/ 94.2% and 5 擄/ 25 擄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.
【作者單位】： 北京積水潭醫(yī)院矯形骨科;
【分類號】：R687.4

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