强直性脊柱炎全髋关节置换术中股骨假体的选择。

Pei Yang, Chun-sheng Wang, Kun-zheng Wang, Zhi-Bin Shi, Fu-liang Gong
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引用次数: 0

摘要

目的:探讨强直性脊柱炎(AS)全髋关节置换术中股骨近端形态变化对股骨假体选择的影响。方法:24例(36髋)因AS接受无骨水泥全髋关节置换术(THR)的患者与30例(45髋)无AS的对照组一起纳入本研究。在x线平片的基础上测定两组的Singh指数、根管光照度指数、皮质形态学指数、皮质指数和茎管配合度。结果:AS患者股骨近端骨质疏松更为严重。两组间Singh指数、管径扩张指数、皮质形态指数和茎管配合度差异均有统计学意义(P0.05)。AS患者股骨上端骨质疏松严重,海绵骨质大量流失,由于股骨皮质变薄,股骨上端椎管形态几乎直立。结论:AS合并严重骨质疏松的患者推荐使用骨水泥假体,应采用改良的THR治疗,以保证假体与根管的良好贴合。然而,无骨水泥假体仍然可以在没有明显股骨近端形态学改变的AS患者中取得良好的治疗效果。计算机辅助设计和制造的个性化义肢比现有的义肢更适合AS患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Selection of femoral prosthesis in total hip replacement for ankylosing spondylitis.

Objective: To investigate the implication of morphological changes of the proximal femur in femoral prosthesis selection in total hip replacement for treatment of ankylosing spondylitis (AS).

Methods: Twenty-four patients (36 hips) admitted for cementless total hip replacement (THR) because of AS were enrolled in this study along with the control group of 30 patients (45 hips) without AS. Measurement of the Singh index, canal flare index, morphological index of the cortex, cortical index and stem-canal fit was performed in the two groups on the basis of roentgenograms.

Results: The AS patients had more serious osteoporosis in their proximal femur. There were significant differences between the two groups in Singh index, canal flare index, morphological index of the cortex and stem-canal fit (P<0.05), but not in the cortical index (P>0.05). The AS patients were found to have severe osteoporosis in the upper femur and massive spongy bone loss, so that the morphology of the canal was almost orthostatic in the upper femur because of the thinned femoral cortex.

Conclusion: Cemented prosthesis is recommended for AS patients with severe osteoporosis, who should be treated with revised THR to ensure good fit of the prosthesis to the canal. Cementless prosthesis, however, can still achieve good therapeutic effect in AS patients without significant morphologic changes in the proximal femurs. Computer-aided design and manufacture of individualized prosthesis better suits the AS patients than the currently available prosthesis.

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