股骨近段矢状位纵向劈开成形在全髋置换中的应用

目的 总结股骨近段矢状位纵向劈开成形术行全髋置换术治疗髋关节终极疾病合并股骨干骺段狭窄畸形的疗效。 方法 选择2000年1月-2009年12月收治的18例(22髋)髋关节终极疾病合并股骨干骺段狭窄畸形患者，其中男3例，女15例；平均年龄54岁(41～ 75岁)。单髋14例，双髋4例。按Berry分类法，全部患者均被确定为干骺段畸形和大小异常型，其中诊断为发育型(先天性髋关节发育不良)17例，陈旧性髋结核1例。先天性髋关节发育不良者按Crowe等分类法，均被诊断为Ⅳ型。所有患者均采用股骨近段矢状位纵向劈开成形、股骨转子下叠加式缩短截骨和“V”形旋转截骨等手术，并采用标准型股骨柄假体生物学固定。 结果 无感染、脱位、下肢神经牵拉伤，以及股骨近段失控性骨折等并发症。术后X线片示臼杯均位于真臼区，所有股骨柄假体的初始固定质量均优良。所有截骨区在术后3～6个月均获骨性愈合。术后测量显示患肢平均延长3 cm(2.5～3.5 cm)。随访1～10年，平均6年，Harris评分由术前的平均30分改善至术后1年的平均93分。X线片显示无骨溶解，或广泛的X线透亮带、假体进行性下沉、内翻移位等假体松动征。无一例因假体松动或其他原因需行翻修手术者。 结论 髋关节终极疾病合并股骨干骺段狭窄畸形者，采用股骨近段矢状位纵向劈开成形术，并采用标准型股骨柄生物固定假体行全髋置换术治疗可取得满意疗效。

Application of proximal femoral shaft splitting at sagittal view in total hip arthroplasty

Objective To summarize the clinical result of the proximal femoral shaft splitting at sagittal view in primary total hip arthroplasty (THA) in treatment of ultimate hip disease combined with femoral metaphyseal stenosis deformity. Methods A retrospective study was done on 18 patients with proximal femoral deformity (22 hips including 14 patients with unilateral hips and 4 with bilateral hips)treated from January 2000 to December 2009.There were three males and 15 females, at age range of 41-75 years (average 54 years).According to Berry classification system, all patients were indentified as metaphyseal segment abnormality and deformity, including developmental type disease (congenital hip dysplasia) in 17 patients and old tuberculosis of the hip in one.The congenital hip dysplasia was diagnosed as type Ⅳ by using the Crowe classification system.All the patients were treated with the proximal femoral shaft splitting, subtrochanteric shortening with overlapping femoral resection and V-shaped derotational osteotomy.In the meantime, standard biological fixation of the femoral stem prosthesis was performed. Results There found no dislocation, infection, lower extremity nerve stretch injury or uncontrolled proximal femur fractures.X-ray showed that all acetabular cups were placed at the anatomical position and that the initial femoral stem prosthesis fixation was rated as good.All osteotomy areas were healed within 3-6 months.Limb length discrepancy was restored to average 3 cm after surgery.The patients were followed up for 1-10 years (average six years), which showed that the average Harris hip score was improved from preoperative 30 to postoperative 93, with no aseptic loosening or osteolysis or radiolucent line around the femoral component, no prosthesis sinking or varus displacement, or no patients needing revision of the femoral component.Conclusions The proximal femoral shaft splitting at sagittal view and standard biological fixation of the femoral stem prosthesis can attain satisfactory result for patients with ultimate hip disease combined with femoral metaphyseal stenosis deformity.