组配型股骨柄治疗翻修术中股骨骨缺损的中期随访

Treatment of bony defects in revision total hip arthroplasty with modular femoral prosthesis: mid-term follow-up study

摘要:

目的  探讨采用组配型股骨柄治疗翻修术中股骨PaproskyⅡ、Ⅲ型骨缺损的中期疗效。方法  选取2007年10月-2012年9月湖南省衡阳市第一人民医院应用组配式股骨翻修柄的18例患者进行回顾性分析。其中，男性10例，女性8例；平均年龄67.6岁（48～80岁）。翻修术距初次置换时间平均为10.3年（1～16年）。翻修原因14例为无菌性松动，4例为股骨头置换后髋臼磨损。术前Harris评分为（41.4±3.8）分,术前VAS评分为（7.4±1.1）分。结果  18例患者全部获得随访，随访时间3～8年，平均5.6年。无感染、无下肢深静脉血栓发生、无假体脱位及松动。2例大腿前侧疼痛，3例轻度跛行。3例股骨假体下沉，下沉<6 mm。末次随访时Harris评分为（84.3±3.1）分，VAS评分为（1.2±0.8）分，与术前比较差异有统计学意义（P <0.05）。结论  采用生物型组配式股骨翻修柄处理翻修术中股骨PaproskyⅡ、Ⅲ型骨缺损的中期疗效满意，能有效缓解疼痛，改善髋关节功能，值得推广。

Abstract:

Objective To explore the mid-term result of use of modular femoral prosthesis for bone defects of Paprosky Ⅱ and Ⅲ in revision total hip arthroplasty. Methods A retrospective study was carried out on 18 patients (18 hips) using modular femoral prosthesis for bone defects of Paprosky Ⅱ and Ⅲ in revision total hip arthroplasty from October 2007 to September 2012. There were 10 males and 8 females with the mean age of 67.6 years (aged from 48 to 80 years). The time from revision to total hip arthroplasty was 1-16 years with the mean of 10.3 years. The causes of revision included aseptic loosening in 14 cases, and acetabulum abrasion after artificial femoral head replacement in 4 cases. Preoperative Harris score was (41.4 ± 3.8), and pain visual analogue score (VAS) was (7.4 ± 1.1). Results All the cases were followed up for an average of 5.6 years (3-8 years). Neither infection nor deep venous thrombosis occurred. Neither prosthetic loosening nor dislocation was observed during the follow-up. Two patients had slight pain in hip, and 3 cases had <6 mm femoral stem subsidence without obvious hip pain or other symptoms. Harris score was (84.3 ± 3.1) and VAS score was (1.2 ± 0.8) at the last follow-up, showing significant differences from the preoperative ones (P < 0.05). Conclusions During the total hip arthroplasty revision surgery, adopting biotype modular femoral prosthesis to repair bone defects of Paprosky Ⅱ and Ⅲ is feasible and the mid-term result is good. It helps to greatly improve the hip function and relieve the pain.