股骨头坏死异体腓骨移植失败后的全髋关节置换-东南大学学报医学版

股骨头坏死异体腓骨移植失败后的全髋关节置换

单位：1. 广州中医药大学, 广东广州 510405;
2. 临沂市人民医院, 山东临沂 276000

分类号：R681.8

出版年·卷·期（页码）：2018·37·第四期（588-593）

摘要：

目的：比较股骨头坏死髓心减压异体腓骨移植术失败后全髋关节置换（THA）与初次治疗即采用THA的疗效。方法：回顾性分析2010年1月至2012年6月行THA的股骨头坏死患者，按纳入、排除标准筛选病例组成研究组与对照组。研究组为31例（34侧）髓心减压异体腓骨移植术失败后行THA的患者，对照组为35例（41侧）同期初次治疗即采用THA的患者。比较两组切口长度、手术时间、术中出血量、术后引流量、输血率、围术期并发症、末次随访Harris髋关节功能评分（HHS）、假体位置及翻修情况。结果：研究组切口平均长度为13.23 cm（12~15 cm），显著长于对照组的12.28 cm（10~15 cm，P=0.038）；术中平均出血量为363.53 ml（300~500 ml），与对照组的356 ml（200~600 ml）无显著差异（P=0.795）；平均手术时间为104.11 min（70~130 min），显著长于对照组的94.4 min（70~120 min，P=0.019）；术后平均引流量499.41 ml（420~600 ml）与对照组的487.6 ml（440~610 ml）无显著差异（P=0.479）；输血率为19.35%，与对照组的25.71%无显著差异（P=0.538）。两组均未出现术中并发症，研究组围术期并发症发生率为3.23%，对照组为5.71%。研究组末次随访HHS平均分为97.3分（92~100分），与对照组的96.6分（92~100分）无显著差异（P=0.340）。研究组髋臼杯外展角平均为44.06°（35°~48°），对照组髋臼杯外展角平均为42.88°（37°~51°），差异无统计学意义（P=0.270）。研究组股骨假体中置率为67.65%，对照组股骨假体中置率为70.73%，差异无统计学意义（P=0.773）。两组随访期间均无翻修病例。结论：髓心减压异体腓骨移植不影响日后THA的疗效，但可能会加大THA手术难度，增加切口长度及手术时间。

Objective:To document the clinical result of total hip arthroplasty following failure of core decompression and allogenic fibular graft. Methods:Thirty-four hip arthroplasty in thirty-one patients who had previous undergone a core decompression and allogenic fibular graft procedure for the treatment of osteonecrosis were retrospectively reviewed, compared with forty-one osteonecrotic hips in other thirty-five patients of total hip arthroplasty without previous allogenic fibular graft. Incision length, intraoperative and postoperative blood loss, blood transfusion rate, operative time, complication rate, positon of the components and postoperative Harris hip score were recorded and compared between the two groups. Results:The mean incision length of the study group was 13.23 cm (range, 12-15 cm), and in the control group it was 12.28 cm (10-15 cm; P=0.038). The mean intraoperative blood loss in the study group was 363.53 ml (range, 300-500 ml), and in the control group it was 356 ml (range, 200-600 ml; P=0.795). The mean postoperative drain volume in the study group was 499.41 ml(rage, 420-600 ml), and the control group was 487.6 ml(rage, 440-610 ml,P=0.479). The blood transfusion rate was 19.35% in the study group, and the control group was 25.71% (P=0.538). The mean operative time in the study group was 104.11 min (range, 70-130 min), and the control group was 94.4 min (range, 70-120 min; P=0.019). Complication rate of the study group was 3.23%, and in the control group it was 5.71% (P>0.05). The mean Harris hip score on the last follow-up day was 97.3(range, 92-100), and the it was 96.6(range, 92-100; P=0.340) in the control group. The mean anteversion angle in the study group was 44.06°(rage, 35°-48°), and it was 42.88° in the control group (37°-51°; P=0.270). The good position rate of stems of the study group was 67.65%, and in the control group it was 70.73% (P=0.773). Conclusion:Previous core decompression and allogenic fibular graft did not affect the outcome of total hip arthroplasty, but may increase operative time and incision length of total hip arthroplasty due to removing the residual graft.

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