大直径股骨头金属对金属全髋关节置换术的中期随访结果  

Mid-term effects of total hip arthroplasty using metal-on-metal prosthesis with large diameter femoral head

作　　者：曾羿[1] 沈彬[1] 杨静[1] 周宗科[1] 康鹏德[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2016年第7期385-391,共7页Chinese Journal of Orthopaedics

基　　金：国家卫生计生委卫生行业科研专项基金（201302007）

摘　　要：目的 探讨大直径股骨头金属对金属全髋关节置换术的中期临床疗效。方法对2007年3月至2009年12月采用大直径金属对金属全髋关节置换术治疗的153例（177髋）晚期髋关节疾病患者进行回顾性分析。通过临床体格检查和影像学表现评价髋关节功能及并发症（假体松动及炎性假瘤形成）的发生率；采用ICP-MS方法测定患者血清中金属钻离子和铬离子浓度，并与正常人群参考值进行比较；以翻修为假体生存终点事件，计算假体五年生存率。结果145例（169髋）获得随访，随访率为94．8％（145／153）；随访时间67-80个月，平均72．4个月。其中男85例（104髋），女60例（65髋）；年龄20±78岁，平均（49．3±12．6）岁。所有患者均采用ASRTM-XL大直径股骨头金属对金属全髋关节假体。末次随访时Harris髋关节评分由术前（44．2±12．6）分提高至（91．5±5．7）分；3例（2．1％，3／145）出现臼杯完全松动、5例（3．4％，5／145）出现髋部炎性假瘤而接受翻修手术。以翻修为终点，术后五年假体生存率为95．3％（161／169）。患者血清钴离子和铬离子浓度分别为2．89μg/L和3．31μg/L，明显高于正常人群参考值（〈0．5μg/L）。结论大直径股骨头金属对金属全髋关节置换术后随访中期可出现臼杯松动和炎性假瘤形成，假体生存率较低。患者血清钴离子和铬离子浓度明显升高。对初次全髋关节置换术，大直径股骨头金属对金属假体不宜作为首选。Objective To evaluate mid-term clinical outcomes associated with total hip arthroplasty using metal-on-metal prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients （177 hips） with advanced hip diseases undergoing large diameter femoral head metal-on-metal total hip arthroplasty in our hospital were retrospectively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications （implant loosening and inflammatory pseudotumor）; ICP-MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values; revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients （159 hips） were followed up for average 72.4 months （67-80 months）, the follow-up rate was 94.8% （145/153）. For the involved patients, 85 were male （104 hips）, 60 were female （65 hips）; age 20-78 years old, average 49.3±12.6 years old. All patients received ASR^TM-XL large femoral head metal-on-metal total hip arthroplasty operation. At the end of follow-up, the average Harris hip score improved from 44.2± 12.6 points preoperatively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout-out and 5 for hip inflammatory pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% （151/159） for revision. Serum cobalt （2.89 μg/ L） and chromium （3.31μg/L） ion levels were significantly increased compared with normal value （〈 0.5 μg/L）. Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout-out and inflammatory pseudotumor might occur for patient receiving large femoral head metal-on-metal THA. The mid-term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal-on-metal prosthesis cannot be the first choice.

关 键 词：关节成形术 置换 髋 假体和植入物 肉芽肿 浆细胞 铬合金 

分 类 号：R687.4[医药卫生—骨科学]