全髋关节置换术后的中远期疗效

Medium-and long-term results of total hip replacement

目的评价全髋关节置换术(THR)后的中远期疗效。方法自1989年4月～1999年3月我院共对232例253髋施行了初次THR。获得随访121例135髋,平均随访9.6年(5.5～15.5年)。手术时患者年龄平均59.5岁(24～93岁)。结果获得随访的135髋存留120髋,其假体存留率为88.9%(120/135),术前Harris评分为67分,术后9.6年评分为86分,其优良率为82.9%(112/135)。10髋因假体松动而行翻修术,总体松动率为7.4%(10/135);2例发生股骨柄和臼杯同时松动,股骨柄的松动率为5.9%(8/135),臼杯的松动率为2.9%(4/135),另有4髋因其它原因翻修,1髋因术后发生感染,取出假体后未再植入假体。股骨柄和臼杯周围骨溶解的发生率分别为25.9%(35/135)和17.8%(24/135)。股骨柄平均下沉2.1mm(0～7mm)。结论THR术后中远期获得了较满意的效果,但X线片示假体周围骨溶解和股骨假体下沉率远高于假体翻修率,患者虽没有明显的临床症状或症状较轻,仍必须密切进行观察。

Objective To evaluate medium-and long-term results of total hip replacement （THR）. Methods From 1989 April to March 1999, 232 patients （253 hips） were treated with primary THR in our hospital. Of them, 121 patients （135 hips） were followed up clinically and radiographically during an average period of 9. 6 years. The average age at the time of the THR was 59.5 years. Results On average, the 9. 6-year survival rate of the prosthesis was 88.9% （120/135） and the Harris hip score was 86 （67 scores before surgery）. The excellent and good rate was 82. 9% （112/135）. 10 hips were revised because of aseptic loosening. The overall loosening rate was 7.4% （10/135, 2 hips experiencing loosening of both stem and cup）. The stem loosening rate was 5.9% （8/135） and cup loosening rate 2.9% （4/135） . 4 hips were revised because of other reasons. 1 prosthesis was taken out because of infection and was not replaced by a new one. Radiographic evaluations showed that the rate of osteolysis surrounding stem and that surrounding cup were 25.9% （35/135） and 17.8% （24/135）, respectively. The average stem subsidence was 2. 1 mm （0-7 mm） . Conclusions The medium-and long-term results of primary THR are satisfactory, but the rate of osteolysis surrounding prostheses and the rate of stem subsidence are found to be much higher than the revision rate. We should watch closely the patients who report no clinic symptoms or signs of aseptic loosening but have radiographic evidence of osteolysis surrounding prostheses and stem subsidence.