Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion.
Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion.
复制标题
股骨粗隆下去旋转截骨术治疗严重股骨前倾的非骨水泥全髋关节置换术。
DOI：
10.1016/s0883-5403(99)90223-1
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
S. Muirhead
中科院分区：
文献类型：
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作者：
Hamid G. Zadeh;J. Hua;Peter S. Walker;S. Muirhead
严重股骨前倾角（bbb50°）的全髋关节置换术（THA）在技术上要求很高。这个问题经常出现在继发于髋关节发育不良或先天性脱位的骨关节炎患者身上。我们描述了一种非骨水泥股骨假体与转子下旋转截骨术联合使用的THA方法。该技术可以恢复正常的股骨近端解剖，包括外展肌杠杆臂，而无需进行大转子转移。股骨过度前倾的矫正避免了术后前路不稳的倾向。截骨部位也可作为股骨短缩或角度矫正的部位，必要时可保留正常的股骨耀斑。所使用的假体是定制的CAD/CAM（计算机辅助设计/计算机辅助制造商）设计的，具有以下特点：髓内近端紧密配合，具有环、外侧圆弧和羟基磷灰石涂层，可实现早期近端固定，纵向切割凹槽柄可在截骨部位提供即时旋转稳定性。虽然我们使用CAD/CAM定制假体，但具有类似设计特征的现成非骨水泥髋关节假体已经可用。我们报告了7例使用该技术行THA手术的患者。患者平均年龄49岁（范围34-61岁），平均随访时间31个月（范围16-60个月）。到目前为止，所有病例都有令人满意的结果，有证据表明截骨部位愈合。Harris髋关节评分从术前平均44分提高到随访结束时的91分。1例患者在截骨部位出现延迟愈合，通过植骨和临时钢板稳定成功矫正。
Total hip joint arthroplasty (THA) in the presence of severe femoral anteversion (>50°) is technically demanding. This problem is often encountered in patients with osteoarthritis secondary to hip joint dysplasia or congenital dislocation. We describe a method of THA in which an uncemented femoral prosthesis is used in conjunction with subtrochanteric derotational osteotomy. This technique allows the restoration of the normal proximal femoral anatomy, including the abductor muscle lever arm without resorting to greater trochanteric transfer. Correction of the excessive femoral anteversion avoids the tendency for postoperative anterior instability. The osteotomy site may also serve as the site for femoral shortening or angular correction when required, which preserves the normal femoral flare. The prostheses used were custom CAD/CAM (computer-assisted design/computer-assisted manufacturer) in design and had the following features: a close intramedullary proximal fit, with collar, lateral flare, and hydroxyapatite coating to achieve early proximal fixation, and longitudinally cutting fluted stem to provide immediate rotational stability across the osteotomy site. Although we used CAD/CAM custom prostheses, off-the-shelf uncemented hip prostheses with similar design features have become available. We report on 7 patients who underwent THA using this technique. The average patient age was 49 years (range, 34–61 years) with a mean follow-up period of 31 months (range, 16–60 months). To date, all cases have had a satisfactory outcome with evidence of union at the osteotomy site. Harris hip scores improved from an average of 44 preoperatively to 91 by the end of follow-up period. One case was complicated by delayed union at the osteotomy site, which was successfully corrected with bone grafting and temporary plate stabilization.