大直径股骨头金属对金属人工全髋关节置换术后中远期疗效评价及失败原因分析  

Mid- and long-term effectiveness and failure causes analysis of large-head metal-onmetal total hip arthroplasty

作　　者：李金龙[1] 周凯[1] 陈志[1] 王端[1] 周宗科[1] 康鹏德[1] 沈彬[1] 杨静[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：《中国修复重建外科杂志》2017年第2期144-149,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结大直径股骨头金属对金属(以下简称大头金对金)人工全髋关节置换术(total hip arthroplasty,THA)后中远期疗效,分析置换失败原因。方法回顾分析2007年3月—2010年5月采用大头金对金THA治疗的159例(183髋)患者临床资料。男109例(129髋),女50例(54髋);年龄20~78岁,平均50岁。单髋135例,其中左髋69例、右髋66例;双髋24例。初次置换原因:股骨头缺血性坏死74例(93髋),Perthes病1例(1髋),髋关节原发性骨关节炎18例(19髋),髋关节发育不良继发骨关节炎17例(18髋),化脓性髋关节炎治愈后骨关节炎8例(8髋),髋关节创伤性关节炎6例(6髋),股骨颈骨折17例(17髋),强制性脊柱炎髋关节受累8例(11髋),髋关节类风湿性关节炎9例(9髋),成人Still病1例(1髋)。术前Harris评分(45.99±8.07)分,疼痛视觉模拟评分(VAS)为(6.59±0.87)分。结果术后患者切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间1.2~8.2年,平均6.1年。术后15例(17髋)失败,假体5年生存率为91.80%(168/183)。失败原因:炎性假瘤形成4例(4髋),髋臼松动3例(3髋),骨溶解4例(5髋),髋臼松动并炎性假瘤形成3例(3髋),功能失用性表现1例(2髋)。其中9例(11髋)因多种原因未行翻修术;6例(6髋)于初次置换术后1.2~5.4年,平均3.7年行翻修术。末次随访时,VAS评分为(1.72±1.48)分,髋关节Harris评分为(81.37±10.75)分,与术前比较差异均有统计学意义(t=–35.547,P=0.000;t=33.823,P=0.000);其中44髋为优,89髋为良,33髋为可,17髋为差。结论大头金对金THA术后中远期失败率较高,失败原因主要为炎性假瘤形成、髋臼松动和骨溶解。尽快实施翻修手术可有效改善患者功能障碍,提高生活质量。Objective To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty （large-head MoM THA）. Methods Between March 2007 and May 2010, 159 patients （183 hips） underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females （54 hips） and 109 males （129 hips） with an average age of 50 years （range, 20-78 years）. Single hip was involved in 135 cases （left hip in 69 cases and right hip in 66 cases） and double hips in 24 cases. The causes included femoral head necrosis in 74 cases （93 hips）, Legg-Calve-Perthes in 1 case （1 hip）, osteoarthritis in 18 cases （19 hips）, developmental dysplasia of the hip in 17 cases （18 hips）, osteoarthritis after hip septic infection in 8 cases （8 hips）, traumatic arthritis of the hip in 6 cases （6 hips）, femoral neck fracture in 17 cases （17 hips）, ankylosing spondylitis in 8 cases （11 hips）, rheumatoid arthritis of hip in 9 cases （9 hips）, and adult onset Still＇s disease in 1 case （1 hip）. Before operation, visual analogue scale （VAS） was 6.59±0.87; Harris score was 45.99±8.07. Results Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years （mean, 6.1 years）. Implant faliure was observed in 15 cases （17 hips）, and the 5-year survival rate of large-head MoM THA was 91.80% （168/183）. The causes of implant failure after THA were inflammatory pseudotumor in 4 cases （4 hips）, acetabular aseptic loosening in 3 cases （3 hips）, osteolysis in 4 cases （5 hips）, acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases （3 hips）, and functional disused in 1 case （2 hips）. Of them, 9 cases （11 hips） did not receive revision surgery for various reasons, while 6 cases （6 hips） underwent revision surgery at 1.2-5.4 years （mean 3.7 years） after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81

关 键 词：人工全髋关节置换 大直径股骨头假体 金属对金属 翻修术 

分 类 号：R687.4[医药卫生—骨科学]