金对金髋关节表面置换术的中长期疗效  

Mid- and long-term effects and related factors of metal-on-metal hip resurfacing arthroplasty

作　　者：姜文学[1] 周思佳 尤佳[1] 王鹏飞[1] 万彦林 雷新玮[1] 王宝奎 Jiang Wenxue;Zhou Sijia;You Jia;Wang Pengfei;Wan Yanlin;Lei Xinwei;Wang Baokui(Department of Orthopaedic Surgery,Tianfin First Center Hospital,Tianfin 300192,China;First Central Clinical College,Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院骨科,300192 [2]天津医科大学一中心临床学院,300192

出　　处：《中华骨科杂志》2018年第17期1025-1035,共11页Chinese Journal of Orthopaedics

摘　　要：目的探讨金对金髋关节表面置换术的中长期疗效及其影响因素。方法回顾性分析2005年6月至2013年1月接受金对金髋关节表面置换术并有完整随访资料的患者64例81髋，男35例44髋，女29例37髋；年龄（48．26±10．45）岁（范围20-65岁）。单侧47例，双侧17例。术前诊断为髋关节发育不良继发骨关节炎23例29髋，股骨头坏死19例22髋，骨关节炎8例10髋，类风湿关节炎5例9髋，强直性脊柱炎6例8髋，色素绒毛结节性滑膜炎2例2髋，髋臼内陷症1例1髋。随访时通过髋关节正位和蛙式位x线片观察髋臼外展角、假体柄干角、假体松动、骨吸收、股骨颈缩窄及异位骨化等影像学表现；通过MR或超声检查判断假性肿瘤的大小及类型；通过Harris髋关节评分、加利福尼亚大学洛杉矶分校（University of California at Los Angeles，UCLA）评分评估临床疗效；以假体翻修为终点计算假体生存率。结果随访时间（7．98±2．21）年（范围5．0-12．8年）。末次随访时Harris髋关节评分[（92．01±5．69）分]显著高于术前[（41．93±9．09）分]，UCLA疼痛、行走、功能和活动评分[分别为（9．37±0．86）分、（9．14±1．01）分、（8．77±1．09）分、（6．47±1．27）分]高于术前[分别为（3．57±1．23）分、（5．99±1．30）分、（5．00±1．01）分、（3．84±1．41）分]；髋关节屈曲、内收外展和内旋外旋活动度较术前增加。出现并发症10髋，发生率12．3％（10／81）。早中期并发症8髋（9．9％，8／81），包括术中股神经损伤1髋、术中隐神经损伤和股深动脉损伤1髋、术后髋关节不明原因疼痛1髋、术后股骨颈骨折1髋、异位骨化3髋、假性肿瘤1髋；中长期并发症2髋（2．5％，2／81），包括股骨颈缩窄1髋和术后9年出现的假性肿瘤1髋。假体翻修1例2髋，其中1髋为股骨颈骨折、另1髋为假性肿瘤。术后5年Kaplan—Meier假体Objective To investigate the mid- and long-term effects of metal-on-metal hip resurfacing arthroplasty （HRA）, and to analyze its related factors. Methods A total of 64 patients （81 hips） who underwent metal-on-metal HRA from June 2005 to January 2013 were recruited in the present study. There were 35 males （44 hips） and 29 females （37 hips） with the mean age of 48.26e 10.45 years （20-65 years）, including 47 unilateral and 17 bilateral HRAs. The cohort consisted of osteoarthri- tis secondary to the developmental dysplasia of the hip （23 cases, 29 hips）, necrosis of the femoral head （19 cases, 22 hips）, osteo- arthritis （8 cases, 10 hips）, rheumatoid arthritis （5 cases, 9 hips）, ankylosing spondylitis （6 cases, 8 hips）, pigmented villonodular synovitis （2 cases, 2 hips） and Otto＇s disease （1 case, 1 hip）. During the follow-up duration, radiographic features, including acetab- ular inclination angle, stem-femoral shaft angle, component loosening, osteolysis, femoral neck narrowing and heterotopic ossifica- tion, were evaluated by hip X-rays in straight and froglike position. The size and type of pseudotumor were assessed by MRI and ul- trasonography. Clinical efficacy was evaluated by Harris hip score and the University of California at Los Angeles （UCLA） hip score. Considering revision surgery as the end point, the component survivorship was calculated. Results The mean follow-up was 7.98±2.21 years, ranging from 5.0 to 12.8 years. The mean postoperative Harris hip score （92.01 ±5.69） was higher than the preoperative score （41.93±9.09）. The mean postoperative UCLA pain, walking, function, activity scores （9.37±0.86, 9.14± 1.01, 8.77± 1.09, 6.47± 1.27, respectively） were improved when compared with the preoperative UCLA scores （3.57± 1.23, 5.99± 1.30, 5.00± 1.01, 3.84± 1.41, respectively）. The postoperative flexion, abduction and adduction, medial and lateral rotation of the hip was larger than the preoperative ones. Complications occur

关 键 词：关节成形术 置换 髋 手术后并发症 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]