不同直径股骨头假体在股骨头坏死患者全髋关节置换术后早期不稳定翻修术中的应用  

Application of femoral head prostheses with different diameters in early unstable revision surgery after total hip arthroplasty in patients with femoral head necrosis

作　　者：程勇[1] 李全义[2] 程莹 CHENG Yong;LI Quanyi;CHENG Ying(Shaanxi Energy Institute,Xi'an 710613,China;Department of Orthopedics,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Shaanxi Metallurgical Hospital,Xi'an 710043,China)

机构地区：[1]陕西能源职业技术学院,陕西西安710613 [2]陕西省人民医院骨科,陕西西安710068 [3]陕西冶金医院,陕西西安710043

出　　处：《实用医院临床杂志》2019年第4期59-62,共4页Practical Journal of Clinical Medicine

基　　金：陕西省社会发展科技攻关项目(编号:2017SF289)

摘　　要：目的探讨不同直径股骨头假体在股骨头坏死患者全髋关节置换术后早期不稳定翻修术中的应用。方法 82例全髋关节置换术后早期不稳定接受翻修术的股骨头坏死患者,根据使用的金属头直径不同分为观察组和对照组各41例。观察组采用36 mm直径股骨头假体翻修,对照组采用28 mm直径股骨头假体翻修。比较两组手术情况、髋关节功能评分、金属离子浓度及随访1年关节活动度、假体脱位率、假体磨损率情况,观察术前术后X射线片检查结果。结果两组手术时间、术中出血量、输血量、术后引流量、住院时间比较差异无统计学意义(P>0. 05);观察组术后8周痛疼评分、功能评分、活动评分、畸形评分、Harris评分高于对照组,钴离子和铬离子浓度低于对照组(P<0. 05);两组钼离子比较差异无统计学意义(P>0. 05);观察组术后1年关节活动度、假体磨损率高于对照组,假体脱位率低于对照组(P<0. 05);X射线片检查结果:术前可见变形和塌陷股骨头,其关节间隙变窄或消失;术后可见股骨假体位置良好无脱位,锥度磨损及摩擦界面磨损较多。结论大直径股骨头假体在股骨头坏死患者全髋关节置换术后早期不稳定翻修术中发挥了良好的疗效与安全性,对患者髋关节功能、关节活动度的改善以及假体脱位率的降低均具有积极意义,但大直径假体存在一定的磨损风险,需加以重视。Objective To explore the application of femoral head prostheses with different diameters in early unstable revision surgery after total hip arthroplasty in patients with femoral head necrosis.Methods Eighty-two patients with femoral head necrosis undergoing revision surgery after total hip arthroplasty were divided into observation group and control group,41 in each group according to the diameter of the metal head.The observation group was treated with 36-mm diameter femoral head prosthesis,and the control group was treated with 28-mm diameter femoral head prosthesis.The operation conditions,hip function score,and metal ion concentrations as well as prosthesis dislocation rate,prosthesis wear rate and joint mobility after 1-year follow up were compared between the two groups.The x-ray results were observed before and after operation.Results There was no significant difference in the operation time,intraoperative blood loss,blood transfusion volume,postoperative drainage volume and hospitalization time between the two groups (P> 0. 05).The pain score,functional score,activity score,malformation score and Harris score of the observation group were significantly higher than those of the control group after 8 weeks of operation (P<0. 05).Cobalt and chromium ion concentrations were lower of the observation group than those of the control group (P < 0. 05) but there was no significant difference in molybdenum ion concentration between the two groups.The degree of joint mobility and prosthesis wear rate were significantly higher and the prosthesis dislocation rate was significantly lower in the observation group than those in the control group after 1 year of operation (P<0. 05).Conclusion Large-diameter femoral head prosthesis shows good efficacy and safety in early unstable revision surgery after total hip arthroplasty in patients with femoral head necrosis.It has a positive significance for the improvement of hip function and joint mobility as well as a reduction of prosthesis dislocation rate.However,large-diameter

关 键 词：股骨头坏死 全髋关节置换术 早期不稳定 大直径股骨头 

分 类 号：R681.8[医药卫生—骨科学] R687.4[医药卫生—外科学]