摘要
背景:髓腔解剖交锁股骨假体为圆柱柄,文献报道其临床疗效满意,但也有研究显示有些患者出现大腿痛,骨改建引起的股骨近端骨丢失,以及磨损碎屑相关的骨溶解等。F2L股骨假体为锥形柄,文献报道临床疗效满意,大腿痛的发生率较低。目的:对比观察髓腔解剖交锁与F2L生物型股骨假体全髋关节置换的中长期疗效。方法:1997年11月至2005年1月采用生物型股骨假体行全髋关节置换60例66髋,52例58髋获得随访。其中采用髓腔解剖交锁生物型股骨假体24例26髋,随访10年3个月至15年5个月;采用F2L生物型股骨假体28例32髋,随访8年3个月-11年1个月。通过临床Harris评分和X射线片进行疗效观察。假体的生存率采用Kaplan-Meier分析,以股骨假体的无菌性松动和任何原因所致的翻修为终点。结果与结论:末次随访时髓腔解剖交锁组和F2L组的Harris评分差异无显著性意义(P>0.05)。置换后F2L组大腿痛的发生率明显低于髓腔解剖交锁组(P<0.05)。髓腔解剖交锁组应力遮挡1度21髋(81%),2度5髋(19%);F2L组应力遮挡0度20髋(62%),1度12髋(38%),两组差异有显著性意义(P<0.05)。髓腔解剖交锁组的应力遮挡与F2L组差异有显著性意义(P<0.05)。F2L组骨溶解的发生率明显低于髓腔解剖交锁组(P<0.05)。Kaplan-Meier分析髓腔解剖交锁股骨假体和F2L假体生存率均为1.0(95%可信区间:0.98-1.00)。提示髓腔解剖交锁股骨假体和F2L生物型股骨假体全髋关节置换长期疗效满意,F2L组大腿痛及骨溶解的发生率显著低于髓腔解剖交锁组。
BACKGROUND:Anatomic medul ary locking (AML) femoral prosthesis is circular cylinder and has satisfactory efficacy. However, some scholars found the complications such as thigh pain, loss of bone at the proximal end of the femur, and wearing-related osteolysis. F2L femoral prosthesis is cone-shaped and also has satisfactory efficacy, but the thigh pain incidence is relatively low. OBJECTIVE:To compare the intermediate-long term results of AML versus F2L in total hip arthroplasty. METHODS:Between November 1997 and January 2005, we retrospectively reviewed 60 patients (66 hips) undergoing total hip arthroplasty using biological femoral prosthesis. At fol ow-up examination, 58 hips in 52 patients were available for clinical and roentgenographic review. 26 AML devices were placed in 24 patients,&amp;nbsp;and 32 F2L devices were placed in 28 patients. The AML group were reviewed with an average of 12.7 years fol ow-up (range 10 years and 3 months to 15 years and 5 months), while the F2L group were reviewed with an average of 9.5 years fol ow-up (range 8 years and 3 months to 11 years and 1 month). The clinical results were evaluated with Harris methods and X-ray examination. Kaplan-Meier analysis was performed to evaluate the survival of femoral component. End point was radiographical loosening or revision of the femoral component for any reason. RESULTS AND CONCLUSION:There were no significant difference between AML and F2L about Harris score in the latest fol ow-up (P〉0.05). After surgery, the incidence of thigh pain was significantly lower in F2L group than that in AML group (P〈0.05). In AMKL group, the stress-shielding 1 level was observed in 21 hips (81%), and 2 level in five hips (19%);in F2L group, the stress shielding 0 level was observed in 20 hips (62%) and 1 level in 12 hips (38%). There were significant differences between the two groups (P〈0.05). The stress shielding showed significant differences between the two groups (P〈0.05). The incidence of osteolysis in F2L group was significantly lower than that in AML group (P〈0.05). Kaplan-Meier analysis showed that, the survival rate of both AML and F2L components were 1.0 (95%confidence interval:0.98-1.00). Experimental findings indicate that, both AML and F2L femoral prosthesis have a satisfactory long-term efficacy after total hip arthroplasty, and the incidence of thigh pain and osteolysis is significantly lower in F2L group.
出处
《中国组织工程研究》
CAS
CSCD
2014年第44期7053-7060,共8页
Chinese Journal of Tissue Engineering Research