陶瓷-陶瓷全髋关节置换术中大小直径股骨头的早期比较  

Analysis of the preliminary clinical results of application of different diameters of femoral head in ceramic on ceramic total hip arthroplasty

作　　者：沈锋[1,2] 唐昊[2] 黄建明[2] 扶晓明[2] 眭杰[2] 刘碧峰[2] 林志金[2] 康一凡[2] 

机构地区：[1]南京军区福州总医院第一附属医院骨科,福建莆田市351100 [2]第二军医大学附属长海医院骨科,上海长海路168号200433

出　　处：《中国矫形外科杂志》2011年第6期463-467,共5页Orthopedic Journal of China

摘　　要：[目的]分析陶瓷-陶瓷全髋关节置换术中分别应用不同直径的股骨头的临床效果,并作相应的比较。[方法]2008年9月～2009年10月,本院共施行136例(157髋)陶瓷-陶瓷全髋关节置换术,其中男59例(68髋),女77例(89髋),年龄27～81岁(平均61.3岁);均采用德国LINK BetaCupTM复合陶瓷界面非骨水泥压配固定髋臼系统进行全髋关节置换;术前诊断显示股骨头缺血性坏死76髋,发育性髋关节脱位46髋,骨关节炎15髋,强直性脊柱炎11髋,类风湿性关节炎3髋,股骨颈骨折GardenⅣ型6髋。术中根据髋臼磨挫直径大小选择相应的股骨头假体(直径分别为28,32,36 mm),根据股骨头假体的直径大小分为3组,Φ28 mm组69髋,Φ32 mm组31髋,Φ36 mm组57髋,通过术前及术后的Harris评分了解髋关节功能及疼痛的改善情况。[结果]随访时间12～18个月(平均16.2个月),Φ28 mm、Φ32 mm、Φ36 mm股骨头术前Harris总评分、疼痛评分、功能评分、活动范围评分比较无明显差异(P>0.05),术后Harris总评分、疼痛评分、功能评分比较无明显差异(P>0.05),每组术后Harris评分较术前明显改善(P<0.05),股骨头直径越大术后活动范围改善就越明显(P<0.05)。[结论]陶瓷-陶瓷全髋关节置换术股骨头直径的选择对术后疼痛的缓解差异性并无影响,但在髋关节活动范围改善方面大直径的球头要优于小直径的球头。陶瓷-陶瓷全髋关节置换术对手术技术及患者自身条件的要求较高,不可盲目追求大直径而忽略髋臼的实际承载条件。[Objective]To analyze clinical results of different diameter of femoral head in the ceramic on ceramic total hip arthroplasty,and compare with each other accordingly. [Method]From September 2008 to October 2009,136 cases（157 hips） were performed ceramic on ceramic total hip arthroplasty in our hospital,59 patients（68 hips） were male,female 77 cases（89 hips）,aged 27-81 years（mean 61.3 years）.LINK BetaCupTM composite ceramic interface cementless press-fit acetabular fixed system was used in total hip replacement.Preoperative diagnosis of avascular necrosis were found in 76 hips,developmental dislocation 46 hips,15 hips with osteoarthritis,ankylosing spondylitis 11 hips,rheumatoid arthritis 3 hips,femoral neck fracture Garden Ⅳ type 6 hips.In accordance with the diameter of the grinding acetabulum,the appropriate femoral head prosthesis（diameters 28 mm,32 mm,36 mm）was selected.According to the diameter of the femoral head prosthesis,patients were divided into 3 groups：69 hips of Φ28 mm group,31 hips of Φ32 mm group,57 hips of Φ36 mm group.Through the preoperative and postoperative Harris hip score improvement of function and pain were assessed. [Result]All cases were followed up for 12 months to 18 months（average 16.2 months）.Φ28 mm,Φ32 mm,Φ36 mm femoral head preoperative Harris total score,pain score,function score,range of motion score showed no significant difference（P0.05）.Postoperative total Harris score,pain score,function scores showed no significant difference（P0.05）.After surgery Harris score improved significantly（P0.05）compared with preoperative ones in each group.Bigger femoral head diameter got greater range of motion after surgery（P0.05）. [Conclusion]The different choice of femoral head diameter in ceramic on ceramic total hip arthroplasty does not affect the pain mitigation postoperativey.But in hip range of motion improvement,large diameter femoral head is superior to the small diameter of the femoral head.Ceramic on ceramic total hip arthroplasty

关 键 词：全髋关节置换 陶瓷-陶瓷 人工关节 股骨头直径 

分 类 号：R687.4[医药卫生—骨科学]