肖龙华 张祖炜 康清华 邓兴武 刘常智

[摘要] 目的 評价自体骨打压植骨术在生物型人工髋关节初次置换术中的应用效果，探讨其临床适用性。 方法 回顾性分析2007年1月～2014年1月于本院就诊采用生物型人工髋关节初次置换术联合自体骨打压植骨术治疗的62例患者，作为试验组，另选择同时期于我院就诊治疗的60例单纯采用生物型人工髋关节初次置换术患者，作为对照组。随访观察两组患者手术前后的髋关节Harris评分及VAS 评分，同时复查X线片以了解假体松动情况。 结果 两组患者手术前的Harris、VAS 评分比较，差异均无统计学意义（P>0.05），治疗后，Harris评分升高，VAS评分降低，差异有统计学意义（P<0.05），且试验组患者Harris及VAS 评分的改善情况显著优于对照组（P<0.05）。随访试验组患者治疗后未出现假体松动，而对照组患者出现4例假体松动，发生率为6.7%，两组患者的假体松动发生率比较，差异有统计学意义（χ2=4.2734，P=0.0387）。 结论 自体骨打压植骨术在生物型人工髋关节初次置换术中的疗效显著，可以有效改善疼痛及髋关节功能，且假体松动发生率低，适合临床长期推广应用。

[关键词] 自体骨打压植骨术；生物型人工髋关节初次置换术；假体松动

[中图分类号] R687.4 [文献标识码] A [文章编号] 1674-4721（2016）03（a）-0092-04

[Abstract] Objective To evaluate the application effect of autologous bone impaction grafting operation in biological artificial hip initial replacement surgery and explore its clinical applicability. Methods From January 2007 to January 2014，62 patients visited our hospital and provided with biological artificial hip initial replacement surgerys combined with autologous bone impaction grafting for treatment were retrospectively analyzed，and they were selected as experimental group.60 patients treated only by simple biological artificial hip initial replacement surgery at the same period was classified into control group.Harris score and visual analogue scale （VAS） score of hip joint before and after operation of patients in two groups was observed after follow-up.Prosthetic loosening was understood by X-ray at the same time. Results There was no statistical difference of Harris and VAS score before operation between two groups （P>0.05）.After operation，Harris score was increased，while VAS score was decreased with statistical significance （P<0.05）.The improvement of Harris and VAS in experimental group was superior to that in control group respectively （P<0.05）.After follow-up，there was no prosthetic loosening occurred in experimental group，while in control group，4 cases occurred，the incidence rate was 6.7%，and there was a statistical difference of incidence rate of prosthetic loosening between two groups （χ2=4.2734，P=0.0387）. Conclusion Autologous bone impaction grafting can obtain a remarkable effect in biological artificial hip initial replacement surgery，and it can effectively improve pain and hip joint function with a lower incidence rate of prosthetic loosening，which is suitable for long-term promotion and application in clinic.

[Key words] Autologous bone impaction grafting；Biological artificial hip initial replacement surgery；Prosthetic loosening

随着交通事故不断增加，中国老年化的进程，老年性股骨颈骨折、股骨头坏死和骨性关节炎的发病率不断增高，需要初次人工髋关节置换的患者也逐年增多[1-2]。以往临床对老年性股骨颈骨折、股骨头坏死和骨性关节炎患者行人工髋关节置换时，由于患者骨质疏松严重等原因，常需要合并骨水泥治疗；另一方面由于患者股骨颈和股骨头废弃，股骨端扩髓等，人为造成了患者的许多骨质丢失，对治疗均有不利影响[3-4]。我院近年来采用生物型假体人工髋关节置换术联合自体骨打压植骨治疗老年性股骨颈骨折等疾病均获得了优良的近期和中远期效果，且该手术方法简单，不需要特殊器械和辅助的生物材料，不增加患者的出血和费用，同时极大程度地保留了患者的自体骨。