- 期刊
Hip Arthroplasty for Osteonecrosis in Patients with Systemic Lupus Erythematosus
全身性紅瘢性狼瘡病人股骨頭壞死之髖關節置換手術
摘要
有23位全身性紅瘢性狼瘡病人，因股骨頭壞死，共37 個髖關節接受人工關節置換術，包含有19 個半套雙極性人工髖關節（BH ) ，及18個全人工髖關節（THA ) ，從1984年七月到1996年7月於本院完成手術。這些病人以回溯性的比較BH 與THA 的結果，其中一位病人接受右側THA及左側BH於術後一年死亡，不列入這個報告中，接受BH及THA這兩組病人中再以術前骨壞死的程度已Ficat的方怯分類。平均追蹤時間在THA 組為44.5個月（24~85月），在BH 組為70.2 個月（24~119月）。 BH組和THA 組的術前平均Harris 功能評分分別是56 . 7 土1 . 09 和50 . 7 土1 . 29 ，而術後最後追蹤的BH 組為81.9±4.37 , THA 組為95.5±0.79 0 THA 組的臨床成組比BH 組好，但是在BH 組中，那些術前骨壞死程度在FlcatH 的病人成績則和THA 組的一樣好。BH 組中有4 個則分別在術後39月至113月（平均63.2月）時因髖臼軟骨磨損或嚴重鼠蹊部疼痛，接受改換成THA 的手術。BH 組的失敗率偽27.8 % ( 5 / 18 ) ，而THA 組則沒有鬆脫或須再手術置換的病人。雖然兩組追蹤的時間不同，但是在臨床的成績上，THA 組有明顯優於BH 組，尤其是當股骨頭已經崩塌時。考慮到全身性紅瘢性狼瘡病人較短的預期生命，我們支持股骨頭壞死在這些病人身上，實行THA 比BH 合適，但在股骨頭部尚未崩塌之時，則BH 的治療效果與THA 一樣好，因此BH 仍不失為股骨頭崩塌前之一良好治療選擇。
關鍵字
無資料並列摘要
Thirty-seven hip arthroplasties including 19 bipolar hemiarthroplasties(BH)and 18 total hip arthroplasties(THA)were performed in our hospital in 23 patients with systemic lupus erythematosus(SLE)for femoral head osteonecrosis between July 1984 and July 1996. These patients were followed up retrospectively to compare the results of BH and THA. One case with right side BH and left side THA expired about 1 year after operation and was excluded from this study. In both groups, these hips with pre-operative osteonecrosis were subclassified in Ficat and Arlet classification. The mean duration of follow-up was 44.5 months (24~85 months) for THA and 70.2 months (24~119 months) for BH. The mean Harris scores pre-operatively were 56.7±1.09 points in the BH group and 50.7±1.29 points in the THA group. The mean post-operative scores were 81.9±4.37 points in the Bli group. and 95.5±0.80 points in the THA group at final follow up. The clinical results of the THA group were better than those of the BR group. However, at an early stage before collapse of the femoral head (Ficat stage II), the results of RH were as good as those of THA. Five BH were converted to THA at the time ranging from 39 months to 113 months (mean 63.2 months) after primary operation due to acetabular cartilage wearing or severe groin pain. The failure rate of BH group was 27.8% (5/18). There was no loosening or revision in the THA group. Although the follow-up durations were different in these two groups, the clinical result was obviously superior in the THA group, particularly after the femoral heads had collapsed. Considering the relatively short life span of SLE patients, we prefer THA over BR in the treatment of the femoral head osteonecrosis in SEE patients. However, based on our results, BH is still a very good choice of treatment before the collapse of the femoral head.
延伸閱讀
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