对比股骨开窗技术和大转子延长截骨术在股骨侧翻修术中的疗效

周俊洁; 周锦; 陈佳晖; 李彪; 杨毅

doi:10.12259/j.issn.2095-610X.S20210418

对比股骨开窗技术和大转子延长截骨术在股骨侧翻修术中的疗效

doi: 10.12259/j.issn.2095-610X.S20210418

昆明医科大学第一附属医院骨科，云南昆明　650032

基金项目: 云南省卫生科技计划基金资助项目（2016NS023）

详细信息

作者简介:
周俊洁（1987～），男，云南昆明人，医学硕士，住院医师，主要从事关节外科临床研究工作

通讯作者:
杨毅，E-mail： 532610345@qq.com

中图分类号: R687.4
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出版历程
- 收稿日期: 2020-12-19
- 刊出日期: 2021-04-25

Comparative Study of Windowing the Femur Diaphysis and Extended Trochanteric Osteotomy in Femoral Revision Surgery

Dept. of Orthopedics，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

摘要

摘要: 目的股骨前外侧皮质开窗技术与大转子延长截骨术（ETO）在取出困难的股骨侧假体翻修术中的比较。方法回顾性分析2014年1月至2019年3月在昆明医科大学第一附属医院用股骨开窗技术行股骨侧翻修术患者18例（18髋）。选择同期在使用大转子延长截骨术行翻修患者12例（12髋）作为对照组。记录手术时间及失血量，使用Harris评分、外展肌MRC评分等标准评估髋关节功能，用影像学随访观察假体位置及截骨块愈合情况，评估并记录有无钢丝钢缆相关的并发症。结果（1）手术时间及出血量开窗组与ETO组比较，差异无统计学意义（P > 0.05）；（2）术后开窗组Harris评分及外展肌力MRC评分均高于ETO组比较，差异有统计学意义（ P < 0.05）；（3）随访期间开窗组有2例下沉，但不影响假体稳定性，随访6月后未见进一步下沉；ETO组未见假体下沉及截骨块移位。随访1 a时，所有患者均可负重行走，X线片示两组患者截骨块均愈合；（4）短期回访未见钢丝钢缆相关的并发症。结论股骨开窗技术与ETO相比，不涉及股骨近端及附着的肌肉，患者可早期主动活动髋关节，且可使用普通生物柄翻修，短期随访示髋关节功能优于ETO组；股骨开窗截骨块较小，可不使用钢缆或钛捆绑带固定而避免环扎固定相关的并发症。
- 髋关节置换翻修术 /
- 股骨侧翻修 /
- 假体 /
- 开窗 /
- 关节成型术
Abstract: Objective To compare windowing the femur diaphysis and extended trochanteric osteotomy for hip implants extraction in revision surgery. Methods We retrospective analyzed data of 18 patients （18 hips） with primary hip arthroplasty undergone windowing the femur diaphysis for implants removal from January 2014 to March 2019. Twelve patients （12 hips） treated with ETO for implants removal associated with femur revision surgery at the same stage were chosen as control group. Operation time and blood loss were recorded, and Harris score and Abductor MRC score were used to evaluate the hip function. Radiographic follow-up was performed to observe the position of the prosthesis and the healing of the osteotomy, and to evaluate and record the presence of complications related to steel wires. Results There was no statistically difference in operation time and blood loss between the two groups （P > 0.05）. The Harris score and abductor muscle strength （MRC） score in the windowing group were higher than those in the ETO group, and the differences were statistically significant （ P < 0.05）. During the follow-up, there were 2 cases of subsidence in the window-opening group, which did not affect the stability of the prosthesis, and no further subsidence was observed after 6 months of follow-up; while no prosthesis subsidence and osteotomy displacement were observed in ETO group. After 1 year of follow-up, all patients were able to walk with weight, and the X-ray films showed that the osteotomy was healed in both groups. No complications related to fixation using a cable or wire cable was seen during short-term follow-up. Conclusion Compared with ETO, the proximal of the femur with the muscle insertions remain intact in windowing technique, so patient can start exercise earlier after operation. And cementless stem can be used for revision surgery. During short-term follow-up, the hip functions in windowing group are better than those in ETO group. The osteotomized fragment in window technique is smaller than ETO, so it can be fixed without cable wire or titanium band and related complications avoided.
- Revision total hip arthroplasty /
- Revision femur /
- Hip prosthesis /
- Windowing /
- Arthroplasty

HTML全文

图 1 股骨开窗手术

A：术中行股骨开窗；B：开窗截骨块；C：未捆钢缆及钢丝，可见开窗骨折线，假体固定稳定。

Figure 1. Windowing the Femur Diaphysis

下载: 全尺寸图片幻灯片

图 2 大转子延长截骨术手术

A：术前可见股骨头脱离假体柄；B：大转子延长截骨；C：骨块回植，钢缆环扎固定，假体固定稳定。

Figure 2. Extended Trochanteric Osteotomy

下载: 全尺寸图片幻灯片

表 1 与ETO组患者术后临床评分比较（ $\bar x \pm s$ ）

Table 1. Comparison of postoperative clinical evaluations with ETO group （ $\bar x \pm s$ ）

组别	n	Harris评分（分）		外展肌力评分（分）
组别	n	6个月	1 a	6个月	1 a
开窗组	18	88.5 ± 2.95	89.7 ± 1.51	4.6 ± 0.50	4.8 ± 0.38
ETO组	12	85.2 ± 1.22	88.8 ± 1.47	NA	4.0 ± 0.00
t/P		t = 3.351	t = 1.650	NA	t = 6.814
t/P		P = 0.002^*	P = 0.111^*	NA	P < 0.001
NA：不可用；^*P < 0.05。

下载: 导出CSV

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