骨水泥型与生物型假体在高龄患者全髋关节置换后早期疗效对比  

Comparison of the early effects of bone cement versus cementless prostheses in very elderly patients undergoing total hip arthroplasty

作　　者：张玉良 吴宏飞 王斌 舒亮 周扬 

机构地区：[1]武警浙江总队嘉兴医院骨一科,314000

出　　处：《中华老年医学杂志》2016年第6期622-625,共4页Chinese Journal of Geriatrics

摘　　要：目的 评价骨水泥型假体与生物型假体全关节置换治疗高龄患者髋关节疾病的早期疗效。 方法 选择2011年3月到2013年3月因髋部疾病行髋关节置换的70岁以上高龄患者110例，104例术后3年随访，其中骨水泥型组（A组）46例，生物型组（B组）58例。观察术中术后情况，术后通过Harris评分评估髋关节功能，通过髋关节X线评估假体松动情况。 结果 术中出血量及术后引流量A组为（236.0±26.3）ml和（123.0±20.3）ml，优于B组（296.0±34.5）ml和（156.0±26.4）ml（P〈0.05）。术前、术后半年、1年、2年、3年Harris评分，A组为（40.2±7.2）分、（80.3±5.2）分、（90.2±4.5）分、（90.6±4.2）分、（90.8±3.5）分，B组为（39.8±6.3）分、（76.5±8.7）分、（86.5±5.1）分、（89.3±4.8）分、（91.0±4.1）分，A组术后半年、1年Harris评分优于B组（P〈0.05），术后2年、3年两组Harris评分差异无统计学意义（P〉0.05）。术前、术后半年、1年、2年、3年疼痛评分，A组为（13.5±5.3）分、（37.5±6.2）分、（38.4±5.3）分、（39.1±2.5）分、（39.0±2.1）分，B组为（12.9±6.2）分、（30.2±8.7）分、（35.9±6.5）分、（38.6±4.8）分、（39.2±2.6）分。术后1年内疼痛A组明显优于B组（P〈0.05），术后2年、3年疼痛（P〉0.05）差异无统计学意义。A组术中出现6例骨水泥反应，其中1例心跳呼吸骤停，经心肺复苏后抢救成功，术后2年出现1例溶骨性疾病。B组术中有4例出现股骨近端骨折，术后3年出现1例溶骨性疾病。 结论 对于行全髋关节置换术的高龄患者，采用骨水泥型及生物型假体均能取得良好的早期疗效。骨水泥型假体在术中出血量、术后引流量、术后1年内关节功能Harris评分中优于生物型假体。术中骨水泥反应值得关注。Objective To evaluate the early effects of bone cement prostheses versus cementless prostheses in very elderly patients undergoing total hip arthroplasty. Methods A total of 110 patients aged 70 years and over who had undergone hip replacement because of hip disease from March 2011 to March 2013 were selected. 104 cases were followed up for 3 years, with 46 cases treated with the bone cement prostheses （Group A） and 58 cases with cementless prostheses （Group B）. The conditions before and after surgery were recorded. Postoperative Harris scores were collected to evaluate the function of the hip joint, and the loosening of hip prostheses was detected by x-ray. Results Intraoperative blood loss and postoperative drainage volume were lower in Group A than in Group B [（236.0±26.3） ml vs. （296.0±34.5） m1,（123.0±20.3） ml vs. （156.0±26.4） ml, both P d0. 051. Harris scores before, 6 months, t, 2 and 3 years after surgery were（40.2-＋ 7.2）, （80.3± 5.2）,（90.2±4.5）,（90.6±4.2）, and（90.8±3.5） in Group A, and（39.8±6.3）,（76.5±8.7）, （86.5±5.1） ,（89. 3±4.8）, and（91.0±4.1） in Group B, respectively. Harris scores 6 months and 1 year after surgery were higher in Group A than in Group B, and there was no significant difference in Harris scores between the two groups 2 and 3 years after surgery（P〈0. 05）. Pain scores before, 6 months, 1, 2 and 3 years after surgery were（13.5 ± 5.3）, （ 37.5 ± 6.2）, （38.4 ± 5.3）, （ 39. 1 ±2.5） and（39. 0±2.1） in Group A and（12.9±6.2）, （30.2±8. 7）,（35.9±6.5）,（38.6±4. 8） and（39.2±2.6） in Group B, respectively. Pain scores 1 year after surgery was better in Group A than in Group B, and there was no significant difference in pain scores between the two groups 2 and 3 years after surgery（P〈0.05）. Bone cement implantation syndrome occurred in 6 cases in Group A, of which 1 ease had respiratory and cardiac arrest and was successfully rescued after eardiopulmonary resuscitatio

关 键 词：生物假体 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]