中国修复重建外科杂志

中国修复重建外科杂志

大直径股骨头金属-金属人工全髋关节置换术的中期疗效

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目的探讨大直径股骨头金属-金属人工全髋关节置换术(total hip arthroplasty,THA)的中期疗效。方法回顾性分析 2009 年 4 月—2010 年 6 月收治并接受大直径金属-金属 THA 治疗 40 例(43 髋)患者临床资料。其中男 18 例(20 髋),女 22 例(23 髋);年龄 20~85 岁,平均 55.1 岁。单髋 37 例,双髋 3 例。股骨头缺血性坏死 14 例(15 髋),原发性骨关节炎 6 例(7 髋),类风湿性关节炎 4 例(4 髋),股骨颈骨折 4 例(4 髋),先天性髋关节发育不良 12 例(13 髋)。术前髋关节 Harris 评分为(38.51±5.62)分,美国加州大学洛杉矶分校(UCLA)评分为(4.21±1.43)分,疼痛视觉模拟评分(VAS)为(6.78±0.95)分。结果患者均获随访,随访时间 6.7~8.3 年,平均 7.5 年。术后切口均Ⅰ期愈合,无神经、血管损伤以及感染、关节脱位等并发症发生。末次随访时,Harris 评分为(93.33±3.21)分、UCLA 评分为(7.32±1.45)分,与术前比较差异均有统计学意义(t=51.753,P=0.000;t=23.232,P=0.000)。术后 3 例(3 髋)发生大腿疼痛,其中 1 例出现软组织炎性假瘤。X 线片复查示,髋臼外展角及前倾角分别为 (46.5±3.2)、(14.8±3.6)°;股骨柄假体初始稳定质量按照 Mulliken 标准评定,获优 39 髋、良 4 髋。随访期间,2 髋发生骨溶解,其中 1 髋继发假体松动行翻修术;其余患者假体无松动、下沉。结论大直径股骨头金属-金属 THA 治疗髋关节终末疾病中期疗效良好。

ObjectiveTo explore the mid-term effectiveness of large-head metal-on-metal total hip arthroplasty (THA).MethodsA retrospective analysis was made on the clinical date of 40 patients (43 hips) who were treated with the large-head metal-on-metal THA between April 2009 and June 2010. There were 18 males (20 hips) and 22 females (23 hips) with an average age of 55.1 years (range, 20-85 years). Unilateral hip was involved in 37 cases and bilateral hips in 3 cases. The disease causes included osteonecrosis of the femoral head in 14 cases (15 hips), osteoarthritis in 6 cases (7 hips), rheumatoid arthritis in 4 cases (4 hips), femoral neck fracture in 4 cases (4 hips), and developmental dysplasia of the hip in 12 cases (13 hips). Before operation, the Harris score and University of California Los Angeles (UCLA) score were 38.51±5.62 and 4.21±1.43, respectively. The visual analogue scale (VAS) score was 6.78±0.95.ResultsAll patients were followed up 6.7-8.3 years (mean 7.5 years). All incisions healed primarily and no neurovascular injury, infection, and hip dislocation occurred. At last follow-up, the Harris score and UCLA score were 93.33±3.21 and 7.32±1.45, respectively, showing significant differences when compared with preoperative scores (t=51.753, P=0.000; t=23.232, P=0.000). The thigh pain occurred in 3 cases (3 hips) in whom the inflammatory pseudotumor of soft tissues was found in 1 case (1 hip). Postoperative X-ray films showed that the acetabular abduction angle and anteversion angle were (46.5±3.2)° and (14.8±3.6) °, respectively. The initial stability of femoral stem prosthesis was excellent in 39 hips and good in 4 hips according to Mulliken standard. Osteolysis occurred in 2 hips and revision was performed in 1 hip of secondary loosening of prosthesis. The rest patients had no prosthesis loosening or sinking.ConclusionThe mid-term effectiveness of large-head mental-on-mental THA in treatment of the terminal diseases of hips are good.

关键词: 人工全髋关节置换术; 大直径股骨头假体; 金属-金属; 中期疗效

Key words: Total hip arthroplasty; large-head prosthesis; metal-on-metal; mid-term effectiveness

引用本文: 王超, 孙俊英, 徐宁, 查俊俊, 王雷. 大直径股骨头金属-金属人工全髋关节置换术的中期疗效. 中国修复重建外科杂志, 2018, 32(4): 389-393. doi: 10.7507/1002-1892.201709087 复制

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