人工全髋关节置换骨水泥和无骨水泥假体术后疗效及假体可能的生存率比较(英文)

Comparison of postoperative curative effect and the possible survival rate of prosthesis following cemented and cementless total hip replacement

背景:人工关节置换者最关心的是人工假体寿命。目的:回顾性方法综合评价人工全髋关节置换术骨水泥和无骨水泥假体术后疗效,以期为延长人工关节的寿命提供经验。设计:随机对照观察。单位:第四军医大学唐都医院全军骨肿瘤研究所、全军骨科中心。对象:解放军第四军医大学唐都医院骨科1993-03/2004-03行人工全髋关节置换术患者356例,获得通讯联系的298例,获得随访105例(108髋),均自愿回访,性别不限,假体类型2000年以前为国产假体,使用国产骨水泥,2000年以后使用美国STRIKER公司的假体,骨水泥由该公司提供。骨水泥中均加有钡剂。患者手术全部由经考核进入人工关节组的医生进行。方法:参照1982年中华外科髋关节人工置换座谈纪要及Mayo人工髋关节疗效评价表,自行设计随访信,对105例(108髋)患者进行随访,其中骨水泥组62例(63髋),无骨水泥组43例(45髋),并对术后患者在疼痛、功能、关节活动范围及X-ray片进行综合性评价和分析。主要观察指标:①患者术后疼痛程度。②患者术后髋关节功能情况。③患者术后关节活动范围。④患者假体周围透亮线、假体水平或垂直移位的距离。⑤患者假体异位骨化的范围。⑥患者股骨近端骨溶解程度。结果:①随访期股前外侧疼痛两组差别不显著[骨水泥组24髋(38.5%),无骨水泥组18髋(40.0%)]。②随访期两组均有跛行。③随访期患者髋关节活动范围160°以上两组无显著差异(骨水泥组62髋,无骨水泥组44髋)。④股骨假体的下沉和髋臼假体的水平、垂直移位两组患者中差别不显著。⑤随访期骨水泥组股骨近端骨密度相对值57.4(9～118),无骨水泥组股骨近端骨密度相对值72.8(14～130),差别不显著。⑥两组患者术后疗效及假体可能生存率,股骨近端广泛骨溶解无显著差异。结论:无论骨水泥假体还是无骨水泥假体患者术后疗效相似,假体都没有达到理想固定的效果。假体类型的选择并不影响假体的寿命,要根据患者的年龄及是否还要行翻修术来决定假体类型;骨溶解与患者年龄、性别、假体类型无关。

BACKGROUND： Patients who suffered total hip replacement are most concerned about the survivorship of prosthesis. OBJECTIVE： To evaluate the postoperative curative effect following cemented and cementless THR with a retrospective method, so as to provide experience for prolonging the survivoship of prosthesis. DESIGN： Randomized and controlled observation. SETTING： General Center of Orthopaedie Department, General Institute of Bone Oncology, Tangdu Hospital, Fourth Military Medical University of Chinese PLA. PARTICIPANTS： We admitted 356 patients who underwent THR from Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University of Chinese PLA between March 1993 and March 2004. Among them, 298 were contacted and 105 （108 hips） followed up. The patients participated in the review voluntarily. They were of either gender and had different types of prosthesis. Prosthesis made in China was adopted before 2000 and prosthesis made in American STRIKER company after 2000; Prosthesis made in China was made of home-made bone cement; Prosthesis bone cement （import） was provided by American STRIKER prosthesis company. Home-made bone cement and import have the same components. Barium was added in beth bone cement . The whole operation was conducted by the physicians who worked in the artificial joint department after examination. METHODS： According to informal discussion summary about total hip replacement of Chinese Journal of Surgery in 1982 and Evaluation Scale of Mayo Total Hip Replacement Curative Effect, we designed follow-up table by ourselves. Totally 105 （108 hips） patients were followed up, among them, 62 （63 hips） were in the cemented group, 43 （45 hips） in the cementless group. Pain, function and motion range of the patients and X-ray were evaluated and analyzed respectively. MAIN OUTCOME MEASURES： ①Postoperative pain degrees. ② Postoperative function of hips. ③ Postoperative motion range. ④ width of light around the prothesis , distance of horizontal or vertical shift of the prosthesis. ⑤ range of ectopic ossification of the prosthesis. ⑥Osteolysis degree of proximal femur. RESULTS： ① There was no significant difference of lateral femoral pain during follow-up period [Cemented group ： 24 hips （38.5%）,cementless group ： 18 hips（40.0%）]. ② Limping appeared in the both two groups ③ There was no significant difference of range.of motion above 160° between two groups （Cemented group： 62 hips; cementless group： 44 hips）. ④There was no significant difference in subsidence of femoral prosthesis and horizontal or vertical shift of acetabular prosthesis between two groups . ④There was no significant difference of relative value of femoral proximal bone density between cemented group [57.4（9-118）] and cementless group [72.8（ 14-130）]. ⑥There was no significant difference of postoperative curative effect , possible survival rate of prosthesis and femoral proximal extensive osteolysis of the patients between the two groups. CONCLUSION： Postoperative curative effect of the patients between cemented group and cementless group are similar, beth not obtaining an ideal fixed effect. The choice of prosthesis type does not affect the survivorship of prosthesis, but it depends on the age of patients to decide whether rebuilding is necessary or not; Osteolysis is not related to age, gender or prosthesis type of the patients.