• 中南大學(xué)湘雅醫(yī)院骨科（長(zhǎng)沙，410008）;

【 摘 要】 目的 探討保留股骨頸（collum femoris preserving，CFP）型人工全髖關(guān)節(jié)置換（total hip arthroplasty，THA）的中期療效。 方法 2004年1 月－2007年2月，對(duì)45例髖關(guān)節(jié)疾病患者行CFP型THA。男29例（31髖），女16例（17髖）；年齡38～60歲，平均48.8歲。左側(cè)20髖，右側(cè)22髖，雙側(cè)3髖。其中骨關(guān)節(jié)炎20例，股骨頭缺血性壞死13例，髖關(guān)節(jié)發(fā)育不良致創(chuàng)傷性關(guān)節(jié)炎4例，類風(fēng)濕性關(guān)節(jié)炎3例，髖臼骨折后創(chuàng)傷性關(guān)節(jié)炎2例，強(qiáng)直性脊柱炎患者2例，Perths病1例。病程2～13年，平均 6.1年。手術(shù)前后攝X線片，行Harris評(píng)分及疼痛視覺(jué)模擬評(píng)分（VAS），測(cè)量關(guān)節(jié)活動(dòng)度；術(shù)后評(píng)估患者步態(tài)，應(yīng)用SF-36簡(jiǎn)明健康狀況調(diào)查量表對(duì)患者生活質(zhì)量進(jìn)行評(píng)估。 結(jié)果45例均獲隨訪，隨訪時(shí)間5～8年，平均6.4年。術(shù)后切口均Ⅰ期愈合，無(wú)感染、髖關(guān)節(jié)脫位、神經(jīng)損傷及深靜脈血栓形成等并發(fā)癥發(fā)生。6例（13.3%）患者術(shù)中發(fā)生假體遠(yuǎn)端股骨外側(cè)皮質(zhì)劈裂骨折，未作特殊處理，均于術(shù)后8個(gè)月骨折愈合。4例（8.9%）患者出現(xiàn)輕度異位骨化，無(wú)特殊不適；5例（11.1%）發(fā)生股骨近端骨密度降低。末次隨訪時(shí)臼杯和假體柄生存率均為100%。術(shù)后1年及末次隨訪時(shí)髖關(guān)節(jié)Harris評(píng)分、VAS評(píng)分、關(guān)節(jié)活動(dòng)度均顯著優(yōu)于術(shù)前（P  lt; 0.05）；術(shù)后1年與末次隨訪時(shí)比較除Harris評(píng)分差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）外，其余各指標(biāo)比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。末次隨訪時(shí)Harris功能評(píng)價(jià)獲優(yōu)31髖、良11髖、中6髖，優(yōu)良率達(dá)87.5%。末次隨訪時(shí)SF-36評(píng)分結(jié)果除了生理職能、軀體疼痛和總體健康得分較四川省城市男性的參考值低（P  lt; 0.05）外，其余各項(xiàng)得分與參考值比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。 結(jié)論CFP型THA中期療效滿意，是股骨頸完整、無(wú)骨質(zhì)疏松年輕患者行THA的一種良好選擇。

引用本文： 李明清,胡懿郃,李康華,廖前德,文霆,鐘達(dá). 保留股骨頸型人工全髖關(guān)節(jié)置換的中期療效. 中國(guó)修復(fù)重建外科雜志, 2012, 26(8): 897-901. doi: 復(fù)制

1. Pipino F, Molfetta L. Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol, 1993, 19(1): 5-12.
2. Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int, 2010, 20 (Suppl 7): 52-57.
3. Briem D, Schneider M, Bogner N, et al. Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop, 2011, 35(5): 655-660.
4. Nowak M, Nowak TE, Schmidt R, et al. Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up. Arch Orthop Trauma Surg, 2011, 131(4): 549-555.
5. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
6. 李寧秀, 劉朝杰, 李俊, 等. 四川省城鄉(xiāng)居民SF-36評(píng)價(jià)參考值. 華西醫(yī)科大學(xué)學(xué)報(bào), 2001, 32(1): 43-47.
7. Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Results of 3, 668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5): 521-529.
8. Kinov P, Radl R, Zacherl M, et al. Correlation between thigh pain and radiological findings with a proximally porous-coated stem. Acta Orthop Belg, 2007, 73(5): 618-624.
9. Callary SA, Campbell DG, Mercer GE, et al. The 6-year migration characteristics of a hydroxyapatite-coated femoral stem a radiostereometric analysis study. J Arthroplasty, 2012, 27(7): 1344-1348.
10. Chambers B, St Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty, 2007, 22(4 Suppl 1): 71-74.
11. Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
12. Gillies RM, Kohan L, Cordingley R. Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement. Comput Methods Biomech Biomed Engin, 2007, 10(2): 97- 102.
13. Hayashi S, Nishiyama T, Fujishiro T, et al. Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity. Int Orthop, 2012, 36(6): 1137-1142.
14. Davidson D, Pike J, Garbuz D, et al. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg (Am), 2008, 90(9): 2000-2012.
15. Thomsen MN, Jakubowitz E, Seeger JB, et al. Fracture load for periprosthetic femoral fractures in cemented versus uncemented hip stems: an experimental in vitro study. Orthopedics, 2008, 31(7): 653.
16. Jakubowitz E, Seeger JB, Lee C, et al. Do short-stemmed- prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg, 2009, 129(6): 849-855.
17. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty, 2009, 24(2): 256-262.
18. Ritter MA, Galley M. Heterotopic bone formation following resurfacing total hip arthroplasty. HSS J, 2011, 7(1): 41-43.
  1. 1. Pipino F, Molfetta L. Femoral neck preservation in total hip replacement. Ital J Orthop Traumatol, 1993, 19(1): 5-12.
  2. 2. Pons M. Learning curve and short-term results with a short-stem CFP system. Hip Int, 2010, 20 (Suppl 7): 52-57.
  3. 3. Briem D, Schneider M, Bogner N, et al. Mid-term results of 155 patients treated with a collum femoris preserving (CFP) short stem prosthesis. Int Orthop, 2011, 35(5): 655-660.
  4. 4. Nowak M, Nowak TE, Schmidt R, et al. Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up. Arch Orthop Trauma Surg, 2011, 131(4): 549-555.
  5. 5. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
  6. 6. 李寧秀, 劉朝杰, 李俊, 等. 四川省城鄉(xiāng)居民SF-36評(píng)價(jià)參考值. 華西醫(yī)科大學(xué)學(xué)報(bào), 2001, 32(1): 43-47.
  7. 7. Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Results of 3, 668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5): 521-529.
  8. 8. Kinov P, Radl R, Zacherl M, et al. Correlation between thigh pain and radiological findings with a proximally porous-coated stem. Acta Orthop Belg, 2007, 73(5): 618-624.
  9. 9. Callary SA, Campbell DG, Mercer GE, et al. The 6-year migration characteristics of a hydroxyapatite-coated femoral stem a radiostereometric analysis study. J Arthroplasty, 2012, 27(7): 1344-1348.
  10. 10. Chambers B, St Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty, 2007, 22(4 Suppl 1): 71-74.
  11. 11. Chen HH, Morrey BF, An KN, et al. Bone remodeling characteristics of a short-stemmed total hip replacement. J Arthroplasty, 2009, 24(6): 945-950.
  12. 12. Gillies RM, Kohan L, Cordingley R. Periprosthetic bone remodelling of a collum femoris preserving cementless titanium femoral hip replacement. Comput Methods Biomech Biomed Engin, 2007, 10(2): 97- 102.
  13. 13. Hayashi S, Nishiyama T, Fujishiro T, et al. Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity. Int Orthop, 2012, 36(6): 1137-1142.
  14. 14. Davidson D, Pike J, Garbuz D, et al. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg (Am), 2008, 90(9): 2000-2012.
  15. 15. Thomsen MN, Jakubowitz E, Seeger JB, et al. Fracture load for periprosthetic femoral fractures in cemented versus uncemented hip stems: an experimental in vitro study. Orthopedics, 2008, 31(7): 653.
  16. 16. Jakubowitz E, Seeger JB, Lee C, et al. Do short-stemmed- prostheses induce periprosthetic fractures earlier than standard hip stems? A biomechanical ex-vivo study of two different stem designs. Arch Orthop Trauma Surg, 2009, 129(6): 849-855.
  17. 17. Rama KR, Vendittoli PA, Ganapathi M, et al. Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty, 2009, 24(2): 256-262.
  18. 18. Ritter MA, Galley M. Heterotopic bone formation following resurfacing total hip arthroplasty. HSS J, 2011, 7(1): 41-43.