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中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 8 -12. doi: 10.3877/cma.j.issn.1674-134X.2018.01.002

所属专题: 文献

临床论著

肿瘤型与常规型人工全髋关节置换股骨假体安放的对比研究
陈宾1, 邹士平1, 王跃辉1, 司文腾1,()   
  1. 1. 450052 郑州市骨科医院
  • 收稿日期:2016-03-27 出版日期:2018-02-01
  • 通信作者: 司文腾

Comparative study on operation techniques of tumor type and conventional type femoral prostheses in total hip replacement

Bin Chen1, Shiping Zou1, Yuehui Wang1, Wenteng Si1,()   

  1. 1. Zheng Zhou Orthopaedics Hospital, Zhengzhou 450052, China
  • Received:2016-03-27 Published:2018-02-01
  • Corresponding author: Wenteng Si
  • About author:
    Corresponding author: Si Wenteng, Email:
引用本文:

陈宾, 邹士平, 王跃辉, 司文腾. 肿瘤型与常规型人工全髋关节置换股骨假体安放的对比研究[J/OL]. 中华关节外科杂志(电子版), 2018, 12(01): 8-12.

Bin Chen, Shiping Zou, Yuehui Wang, Wenteng Si. Comparative study on operation techniques of tumor type and conventional type femoral prostheses in total hip replacement[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(01): 8-12.

目的

通过对比两种人工全髋关节置换手术股骨假体安放的技术,提高对术中股骨假体安放及假体周围软组织修复的认识。

方法

2012年1月至2016年1月,选取郑州市骨科医院骨病骨肿瘤科同期收治的髋部肿瘤、股股骨头坏死、股骨颈骨折行髋关节置换手术治疗的患者,排除肿瘤已全身转移且不宜手术治疗的患者,并随机分为对照组和观察组行人工全髋关节置换者90例95髋,男53例56髋,女37例39髋;年龄12~81岁,平均(55±14)岁。其中行肿瘤型人工全髋关节假体置换者(A组)12例12髋;行常规初次人工全髋关节置换者(B组)78例83髋。术中两组患者参照多处解剖标志安放股骨假体,并最大限度重建假体周围软组织解剖结构。对两组患者的手术时间、术中术后出血量、住院天数和髋关节Harris评分进行秩和检验和方差分析。

结果

两组患者90例获3~30个月的随访,平均(36±7)个月的随访。在手术时间和术中术后出血量上两组比较差异无统计学意义(P>0.05);住院天数两组比较差异有统计学意义(t=2.027,P<0.05)。两组患者术前、术后Harris评分经统计学分析,差异有统计学意义(F=4.662,P<0.05),两组患者其术后髋关节功能得到提高,差异有统计学意义(F=2.679,P<0.05),术后B组患者的髋关节功能优于A组患者。随访期内两组患者均未发现术后下肢不等长、术后关节脱位、感染、假体松动、假体周围骨折、坐骨神经损伤等并发症。肿瘤型假体组1例由于外展肌力不全,出现行走步态异常。

结论

股骨假体位置的正确安放及假体周围组织完整性的保持和术后重建恢复是术后髋关节获得良好功能的前提条件。

Objective

To compare two techniques of femoral prosthesis positioning and the soft tissues repair during total hip arthroplasty(THA) and enhance the comprehension of the surgery.

Methods

From January 2012 to January 2016, a series of 90 patients (95 hips) were enrolled in the study, including 53 males(56 hips) and 37 females (39 hips) of hip tumor, femoral head necrosis or femoral neck fractures, while the patients not suitable for operation were excluded. The average age was (55±14)years. The patients were divided into two groups. In the group of tumor femoral prosthesis (group A), there were 12 patients (12 hips). In the group of conventional femoral prosthesis (group B), there were 78 patients (83 hips). During the operation, the femoral prostheses were placed according to the reference of multiple anatomic landmarks, and the soft tissues around the artificial joint were reconstructed as far as possible. The perioperative data such as operative time, blood loss volume, hospital day as well as the Harris hip score were observed. Rank-sum test and chi-square test were applied for statistical analysis.

Results

The two groups received three to 30 months of follow-up, and the average follow-up time was 21 months. No statistically significant difference was found between group A and group B in the operative time (t=1.014, P>0.05) or blood loss (t=1.922, P>0.05). The hospital day and the Harris hip score showed statistically significant differences between the two groups(t=2.027, P<0.05). The difference between pre-and postoperative Harris hip scores of the two groups was statistically significant(F=4.662 , P<0.05). The difference of Harris hip score between group A and group B was statistically significant(F=2.679 , P<0.05); group B was higher than group A. In the two groups, no leg length discrepancy, dislocation, postoperative infection, aseptic loosening, periprosthetic fracture, nerve injury or other complications was observed. One patient presented abnormal walking in group A, the cause might be the incomplete abductor strength.

Conclusions

It is a prerequisite for the femoral prosthesis being put at a correct position and for the tissues surrounding the artificial joint been reconstructed to obtain a good hip function after operation.

图1 附着点植骨示意图
表2 两组患者手术时间、术中术后出血量及住院天数比较[M(QLQU)]
图3 患者髋部术后X线片,示右髋重建良好,下肢等长
图5 患者髋部术后X线片,示左髋重建良好,下肢等长
[1]
Akbar M,Aldinger G,Krahmer K, et al. Custom stems for femoral deformity in patients less than 40 years of age: 70 hips followed for an average of 14 years[J]. Acta Orthop, 2009, 80(4): 420-425.
[2]
陈宾. 人工全髋关节置换术后下肢长度的变化及影响因素[D]. 郑州:郑州大学,2012.
[3]
林秾,叶招明,李伟栩, 等. 骨肿瘤保肢手术中以人工关节重建股骨上端[J/CD]. 中华关节外科杂志(电子版), 2007, 1(5):275-280.
[4]
郭卫,杨毅,汤小东, 等. 股骨上段肿瘤切除后人工假体重建的临床研究[J]. 中华外科杂志, 2007, 45(10):657-660.
[5]
Malhotra R,Kiran Kumar GN,Digge K V, et al. The clinical and radiological evaluation of the use of an allograft-prosthesis composite in the treatment of proximal femoral giant cell tumours[J]. Bone Joint J, 2014, 96-B(8): 1106-1110.
[6]
梁文清,郑龙坡,蔡郑东, 等. 计算机辅助设计人工假体治疗髋臼周围肿瘤[J]. 中国组织工程研究与临床康复, 2010, 14(4):585-588.
[7]
陶涛,张云坤,郁忠杰. 髋关节置换协同瘤段切除灭活再植治疗股骨近段恶性骨肿瘤的临床研究[J]. 当代医学, 2010, 16(32):82-83.
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