非骨水泥型全髋关节置换术在髋臼骨折术后继发病变中的研究  

The Application of Cement-Free Total Hip Arthroplasty in the Treatment of Secondary Lesions After Acetabular Fractures

作　　者：王波[1] 许珂 刘林[1] 张斌飞[2] 庄岩[3] 郝阳泉[1] 许鹏[1] Wang Bo;Xu Ke;Liu Lin;Zhang Binfei;Zhuang Yan;Hao Yangquan;Xu Peng(Department of Osteonecrosis&Joint Reconstruction Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710000,China;Department of Hip Joint Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710000,China;Department of Orthopaedic Surgery,Honghui Hospital,Xi’an Jiaotong University,Xi’an 710000,China)

机构地区：[1]西安交通大学附属红会医院关节病医院骨坏死与关节重建病区,陕西西安710000 [2]西安交通大学附属红会医院关节病医院髋关节病区,陕西西安710000 [3]西安交通大学附属红会医院创伤骨科,陕西西安710000

出　　处：《实用骨科杂志》2022年第11期961-965,986,共6页Journal of Practical Orthopaedics

基　　金：国家自然科学基金(82072432);陕西省重点研发计划(2022SF-313)。

摘　　要：目的评价非骨水泥型人工全髋关节置换术(total hip arthroplasty,THA)在治疗髋臼骨折术后继发病变的临床效果、影像学结果及术后并发症等,并比较不同涂层假体之间的差异。方法回顾性纳入2015年1月至2017年1月因髋臼骨折术后继发病变在红会医院骨坏死与关节重建病区行THA的65例患者。男39例,女26例;平均年龄(46.5±18.6)岁;35例使用钽金属涂层的假体,30例使用羟基磷灰石涂层的假体。应用髋关节功能评分(harris hip score,HHS)、疼痛视觉模拟评分(visual analog scale,VAS)、生活质量评定量表(12-item short form health survey,SF-12)、臼杯外展角等评价术后功能效果、假体稳定性,并比较不同涂层假体间的术中情况(手术时间、出血量、输血率)、随访时的效果(HHS、VAS、SF-12)、假体生存率及并发症等。结果65例患者平均随访(6.2±0.9)年。术后1年及末次随访结果均较术前有显著改善,差异具有统计学意义(P<0.05)。术后1年与末次随访时臼杯外展角比较,差异无统计学意义(P>0.05)。钽金属涂层组手术时间较短,术后1年随访时HHS更优,术后翻修率更低。3例随访期间因无菌性松动行翻修术。所有患者均未发生深静脉血栓、坐骨神经损伤等并发症。结论在髋臼骨折术后继发病变的治疗中,非骨水泥型THA可以获得满意的中远期临床效果。在选择非骨水泥型人工关节假体时,钽金属涂层假体的术后翻修率更低。Objective To evaluate the clinical results,imaging results and postoperative complications of cement-free prostheses for the treatment of secondary acetabular fractures,and to compare these differences between different coated prostheses.Methods A total of 65 patients who underwent total hip arthroplasty(THA)in the department of Osteonecrosis&Joint Reconstruction Surgery of Honghui hospital from January 2015 to January 2017 due to secondary lesions after acetabular fractures were retrospectively enrolled.39 males and 26 females were included,and the mean age was(46.5±18.6)years.Harris hip score(HHS),visual analog scale(VAS),12-item short form health survey(SF-12)and acetabular cup abduction angle were used to evaluate postoperative functional results and prosthesis stability.The intraoperative conditions(operation time,blood loss,blood transfusion rate),follow-up outcomes(HHS,VAS,SF-12),prosthesis survival rate and complications were compared between different coated prostheses.Results 65 patients were followed up(6.2±0.9)years.The results of the 1-year post-operation and the last follow-up were significantly improved compared with the pre-operation,and the differences were statistically significant(P<0.05).There was no significant difference in the abduction angle of acetabular cup at 1 year and last follow-up(P>0.05).The tantalum coating group had shorter operation time,better HHS and lower revision rate at 1 year follow-up.Three patients underwent revision surgery due to aseptic loosening during follow-up.No complications such as deep vein thrombosis and sciatic nerve injury occurred in all patients.Conclusion In the treatment of postoperative lesions of acetabular fractures,cement-free total hip arthroplasty can achieve satisfactory long-term clinical results.Tantalum metal-coated prostheses have lower revision rates when selecting cement-free prostheses.

关 键 词：全髋关节置换术 非骨水泥型假体 髋臼骨折 

分 类 号：R687.42[医药卫生—骨科学]