髋关节表面置换术后生存分析研究  

Survival analysis of hip resurfacing arthroplasty

作　　者：王一鸣 徐一宏 徐卫东[1] WANG Yi-ming;XU Yi-hong;XU Wei-dong(Department of Orthopedics,Changhai Hospital Affiliated to the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学上海长海医院关节骨病外科,上海医学博士200433

出　　处：《医学研究生学报》2018年第4期377-380,共4页Journal of Medical Postgraduates

基　　金：长海医院青年启动基金(CH201818)

摘　　要：目的目前我国关于金属对金属关节系统的髋关节表面置换(HRA)患者缺乏相关临床生存分析结果的报道。文中旨在对金属对金属关节系统的HRA患者进行了回顾性分析,探究影响假体生存率的因素。方法回顾性分析2005年9月到2010年5月长海医院关节骨病外科行金属对金属关节系统HRA术的113名患者(146髋)的临床资料。所有患者通过电话或门诊随访,平均随访时间为术后10.2年。统计分析患者的临床疗效,并进行Cox比例风险模型分析假体生存率的影响因素。结果随访结束时,共有17例患者(17髋)进行了髋关节翻修手术。患者术后10年的Harris评分[(90.3±10.8)分]较术前[(51.4±7.8)分]显著提高(P<0.001)。骨盆平片评估有6例异位骨化,均为Brooker I型;2例股骨颈缩窄,2例有透亮线,但无明显松动迹象。Kaplan-Meier生存分析结果显示HRA术后10年生存率为87.1%(95%CI:80.8%~93.4%)。Cox比例风险模型分析显示相对于髋臼假体外展角45°~55°,>55°相对危险度为2.381,<45°相对危险度为0.251。结论 HRA术后生存率较高,且假体生存率与髋臼假体安放位置(外展角)相关,应注意髋臼假体外展角>55°时风险较高。Objective At present,there is little report of clinical results of metal-on-metal HRA in China.This study was aimed at retrospectively analyzing the factors of survival rate of HRA in China.Methods A retrospective study was conducted in 113 patients who accepted HRA in our hospital from September 2005 to May 2010.All patients were followed up by telephone or outpatient visit,and the average follow-up time was 10.2 years.The clinical function was evaluated by Harris score,and the prosthesis was evaluated by pelvic film.Inductively coupled plasma mass spectrometry(ICP-MS)was used to detect the concentration of blood metal ions,ultrasound and MRI were used to screen and diagnose inflammatory pseudotumor.Cox proportional hazards models were used to analyze the factors affecting the survival rate of the prosthesis.Results A total of 91 patients(120 hips)were followed up while 22 patients(26 hips)were lost,the follow-up rate was 80.5%.17 patients underwent revision surgeries,including 8 cases of femoral neck fracture and 8 cases of aseptic loosening,the other one was infection.Revision in 13 cases was within 3 years,the proportion was as high as 76.5%.The 10-year survival rate of prosthesis was 87.1%,the abduction angle of acetabular prosthesis is the only risk factor affecting the survival.Conclusion Postoperative survival rate of HRA is relatively high,and the survival rate of prosthesis is relevant to socket position.We should notice that the risk increased when the acetabular abduction angle of the prosthesis was over 55 degree.Overall,HRA is still a successful surgical method.

关 键 词：髋关节表面置换 无菌性松动 生存分析 髋臼假体外展角 

分 类 号：R687.4[医药卫生—骨科学]