陶瓷对陶瓷全髋关节置换术治疗髋关节终末期疾病中长期疗效  

Intermediate and long-term outcomes of ceramic-on-ceramic total hip arthroplasty for end-stage hip disease

作　　者：黄晓楠[1] 张勇[1] 王奇[1] 

机构地区：[1]山东省菏泽市立医院骨外科,274031

出　　处：《中国矫形外科杂志》2014年第16期1458-1461,共4页Orthopedic Journal of China

摘　　要：[目的]评估陶瓷对陶瓷全髋关节置换术（THA）治疗髋关节终末期疾病中长期临床疗效和影像学结果，重点观察磨损、骨溶解、陶瓷碎裂发生率。[方法]2001年5月～2005年5月，共142例（148髋）在本院行陶瓷对陶瓷THA治疗。平均年龄57．2岁（23～81岁），平均随访8．8年（7～12年）。术前诊断：股骨头缺血性坏死77髋（52％）、髋关节退行性骨性关节炎36髋（24．3％）、股骨颈骨折18髋（12．2％）、类风湿关节炎15髋（10．1％）及化脓性髋关节继发关节退变2髋（1．4％）。评估患者术后临床功能（Harris评分）、术后大腿及腹股沟疼痛发生率。影像学评估重点观察是否有磨损、假体周围骨溶解及陶瓷碎裂。[结果]平均Harris评分由术前的58．3分（10～73分）提高到末次随访的92．5分（79～100分）。在末次随访时，有4髋（2．7％）出现腹股沟部疼痛，6髋（4．2％）出现大腿疼痛，这些患者均未发现股骨柄假体松动。共29髋观察到假体周围有非连续性透亮线，其中股骨侧25髋（16．9％），髋臼侧4髋（2．7％）。观察到膜内成骨在股骨侧有95髋（64．2％），在髋臼侧有88髋（59．5％）。股骨侧和髋臼侧均未观察到骨溶解。有2髋（1．4％）出现髋臼杯倾斜角的改变，2髋（1．4％）髋关节脱位，1髋（0．7％）陶瓷头碎裂，1髋（0．7％）出现异响。Kaplan－Meier生存率分析，假体平均术后8．8年存留率为98．1％。[结论]陶瓷对陶瓷THA是治疗髋关节终末期疾病的有效方法，可以获得满意的中长期临床疗效以及较高的假体存留率。[ Objecfive~ To evaluate the long- term clinical and radiographic results of ceramic -on- ceramic total hip ar- throplasty （THA） for end - stage hip disease, focusing on observations on wear, osteolysis, and ceramic fracture. [ Method ] Be- tween May 2001 and May 2005,142 patients （ 148 hips） were treated in our hospital with ceramic - on - ceramic THA. The mean age of the patients was 57.2 years （ range,23 - 81 years）. The mean follow - up period was 8.8 years （ range,7 - 12 years）. The preoperative diagnosis was avascular necrosis in 77 hips （52%） ,degenerative osteoarthritis in 36 hips （24.3%）, femoral neck fracture in 18 hips （ 12.2% ） , rheumatoid arthritis in 15 hips （ 10.1% ） , and septic hip sequelae in 2 hips （ 1. 4% ）. The patients were evaluated, including clinical function, using the Harris hip scoring system, and the incidence of thigh and groin pain was determined. Radiological analysis was performed with special attention on wear,periprosthetic osteolysis, and ceramic failures. [Result]The mean Harris hip score improved from 58.3 （range,10 -73） to 92.5 （range,79 - 100） at the fi- nal follow -up. At the last follow -up,4 hips （2.7%） had groin pain and 6 hips （4.2%） had thigh pain,but these hips were not found with femoral stem loosening. Radiolucent lines were observed around the stem in 25 hips （ 16.9% ） and around the cup in 4 hips （2.7%）. Endosteal new -bone formation was observed around the stem in 95 hips （64.2%） and around the cup in 88 hips （59.5%）. No osteolysis was observed around the stem and cup. Inclination changes of the acetabular cup were ob- served in 2 hips （1.4%） ;moreover, hip dislocation was found in 2 hips （ 1.4% ） ;ceramic head fracture, in 1 hip （0.7%） ; and squeaking,in 1 hip （0.7%）. The Kaplan - Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. [ Conclusion] Ceramic- on- ceramic THA is an effective treatment for end -stage hip disease and can achieve satisfactory lon

关 键 词：全髋关节置换术 陶瓷对陶瓷 疗效 

分 类 号：R687.4[医药卫生—骨科学]