金属对金属全髋关节表面置换治疗中青年中晚期股骨头缺血性坏死  

METAL-ON-METAL TOTAL HIP RESURFACING ARTHROPLASTY FOR TREATMENT OF ADVANCED OSTEONECROSIS OF FEMORAL HEAD IN YOUNG AND MIDDLE-AGED PATIENTS

作　　者：雷鸣[1] 杨述华[1] 许伟华[1] 叶树楠[1] 迮仁浩[1] 范李[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国修复重建外科杂志》2010年第3期262-265,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价金属对金属全髋关节表面置换治疗中青年中晚期股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的早期疗效,并与同期治疗单纯骨性关节炎疗效比较。方法回顾分析2006年7月-2008年10月行金属对金属全髋关节表面置换的33例45髋ONFH患者(ONFH组)临床资料,并与同期行金属对金属全髋关节表面置换的39例45髋骨性关节炎患者(骨性关节炎组)进行疗效比较。ONFH组:男18例27髋,女15例18髋;年龄19～58岁,平均42.7岁。有创伤史4例,糖皮质激素治疗史25例,吸毒史2例,酗酒史1例,银屑病1例。左侧22髋,右侧23髋。按Steinberg分期:Ⅲ期10髋,Ⅳa期18髋,Ⅳb期13髋,Ⅳc期4髋。Harris评分为(52.0±4.6)分。病程为1～12年。骨性关节炎组:男26例30髋,女13例15髋;年龄42～65岁,平均47.1岁。左侧17髋,右侧28髋。退行性骨性关节炎23例,创伤后骨性关节炎11例,强直性脊柱炎继发骨性关节炎5例。Harris评分为(57.0±3.8)分。病程为3～17年。两组患者一般资料比较差异均无统计学意义(P>0.05),具有可比性。结果术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓等并发症发生。患者均获随访,ONFH组随访时间平均26个月,骨性关节炎组平均28个月。术后4个月骨性关节炎组1例发生股骨颈骨折,改行人工全髋关节置换。其余患者均无明显假体松动、脱位,切口感染,骨坏死、吸收等并发症发生。末次随访时ONFH组Harris评分为(93.0±5.5)分,骨性关节炎组为(94.0±2.4)分;两组术后组间比较,差异无统计学意义(P>0.05);组内手术前后比较,差异有统计学意义(P<0.01)。结论金属对金属全髋关节表面置换治疗中青年中晚期ONFH近期临床效果满意,与治疗骨性关节炎效果相似,但仍需积累更多病例及长期临床随访验证中远期疗效。Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head （ONFH） in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients （45 hips） with ONFH （ONFH group） and 39 patients （45 hips） with osteoarthritis （osteoarthritis group） were treated with metal-on-metal total hip resurfacing arthroplasty. In ONFH group, there were 18 males （27 hips） and 15 females （18 hips） with an average age of 42.7 years （range 19-58 years）, including 22 left hips and 23 right hips. The causes were trauma （4 cases）, glucocorticoid （25 cases）, drugs （2 cases）, alcohol （1 case）, and psoriasis （1 case）. According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males （30 hips） and 13 females （15 hips） with an average age of 47.1 years （range 42-65 years）, including 17 left hips and 28 right hips. The causes were degenerative arthritis （23 cases）, trauma （11 cases）, and ankylosing spondyl itis （5 cases）. The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups （P 〉 0.05）. Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores

关 键 词：全髋关节表面置换 金属对金属 中青年 股骨头缺血性坏死 中晚期 

分 类 号：R687.4[医药卫生—骨科学]