高分子聚乙烯假体在人工全髋关节置换术后远期CT成像骨溶解分析

Long-term computed tomographic osteolytic analysis of highly cross-linked polyethylene prosthesis after total hip arthroplasty

目的分析人工全髋关节置换术(total hip arthroplasty,THA)中使用高分子聚乙烯假体在术后随访15年以上的骨溶解发生情况。方法回顾分析2000年6月—2004年4月日本金泽医科大学附属医院收治且符合选择标准的84例(105髋)行THA治疗的髋关节疾病患者临床资料。男7例,女77例;年龄41~75岁,平均56.4岁。继发性髋关节骨关节炎94髋、骨盆截骨术后4髋、原发性髋关节骨关节炎2髋、创伤性髋关节骨关节炎2髋、股骨头坏死2髋、类风湿性关节炎1髋。Crowe分型:Ⅰ型79髋、Ⅱ型19髋、Ⅲ型6髋、Ⅳ型1髋。患者均使用第一代高分子聚乙烯髋臼内衬联合26 mm氧化锆股骨头。术后摄X线片分析髋臼假体周围辐射透光情况及骨溶解发生情况,并于末次随访时测量垂直距离(骨盆下边缘泪滴线与髋关节旋转中心垂线相交处的距离)、水平距离(髋关节旋转中心至泪滴下缘泪滴间线与垂直线相交处的水平距离)、髋臼杯前倾角;并行CT扫描及CT三维多平面重建(three-dimensional multiplanar reconstruction,3D-MPR)分析髋臼和股骨侧骨溶解情况;结合X线片和CT结果,根据Narkbunnam提出的评分标准对骨溶解进行评价。结果术后发生下肢深静脉血栓形成2例。患者均获随访,随访时间15~18年,平均15.9年。术后发生髋关节脱位1髋,假体周围骨折1髋;均未发生髋臼松动或内衬断裂。除1例术后X线片检查发现髋臼处有1条可透射线外,余83例X线片未显示任何髋臼或股骨侧可透射线;无1例患者行髋关节翻修术。末次随访时X线片检查示,髋臼杯前倾角-10°~39°,平均22°;垂直距离3.5~47.1 mm,平均24.6 mm;水平距离22.6~48.1 mm,平均31.7 mm。末次随访时X线片和CT 3D-MPR图像示患者均未出现髋臼或股骨骨溶解,根据Narkbunnam提出的骨溶解评分标准示任何区域均为0分。结论高分子聚乙烯假体不会增加THA术后远期骨溶解并发症风险。

Objective To analyze the occurrence of osteolysis in total hip arthroplasty(THA)with highly crosslinked polyethylene prosthesis during a follow-up of more than 15 years.Methods The clinical data of 84 patients(105 hips)treated with THA in the Affiliated Hospital of Kanazawa Medical University in Japan between June 2000 and April 2004 and met the selection criteria was retrospectively analyzed.There were 7 males and 77 females,aged from 41 to 75 years,with an average of 56.4 years.There were 94 hips with secondary hip osteoarthritis,4 hips after pelvic osteotomy,2 hips with primary hip osteoarthritis,2 hips with traumatic hip osteoarthritis,2 hips with osteonecrosis of the femoral head,and 1 hip with rheumatoid arthritis.According to Crowe classification,there were 79 hips of typeⅠ,19 hips of typeⅡ,6 hips of typeⅢ,and 1 hip of typeⅣ.The highly cross-linked polyethylene acetabular liner combined with a 26 mm zirconia femoral head were used in all patients.X-ray films were taken after operation to analyze the radiation transmission and osteolysis around the acetabular prosthesis.The vertical distance(the distance between the teardrop line at the lower edge of the pelvis and the perpendicular line of the hip rotation center),the horizontal distance(the horizontal distance between the hip rotation center and the interteardrop line and the vertical line at the lower edge of the teardrop),and the acetabular cup anteversion angle were measured at last follow-up.The acetabular and femoral osteolysis was analyzed by CT scan and three-dimensional multiplanar reconstruction(3D-MPR).Combined with X-ray film and CT results,osteolysis was evaluated according to the Narkbunnam score.Results Deep vein thrombosis of lower limbs occurred in 2 cases.All patients were followed up 15-18 years,with an average of 15.9 years.One hip dislocation and 1 periprosthetic fracture occurred postoperatively,and no acetabular loosening or prosthetic lining ruptures occurred.Except for 1 patient who had a radiolucent line in the acetabulum after operation,the other 83 patients did not show any radiolucent line in the acetabulum or the femur.None of the patients underwent hip revision.X-ray films at last follow-up showed an acetabular cup anteversion angle of−10°-39°,with an average of 22°;a vertical distance of 3.5-47.1 mm,with an average of 24.6 mm;and a horizontal distance of 22.6-48.1 mm,with an average of 31.7 mm.There was no acetabular or femoral osteolysis in all patients on X-ray films and CT 3D-MPR images at last follow-up,and the Narkbunnam score was 0 in any region.Conclusion Highly cross-linked polyethylene prosthesis does not increase the risk of long-term complications such as osteolysis after THA.