骨水泥股骨柄和非骨水泥臼杯在首次全髋关节置换术中的应用

Use of cementless acetabular component and cemented femoral component in total hip arthroplasty

目的随访一组采用同一类型骨水泥型股骨假体和非骨水泥型髋臼假体组合在首次人工全髋关节置换术中的应用,并探讨该种混合型假体对于全身健康情况和骨质质量一般较差的老年患者的适用情况。方法共有75例患者84髋得到临床和影像学随访,平均年龄为67．9岁。其中老龄股骨颈骨折患者41例41髋,平均年龄72．1岁。随访时间为4．1年。随访内容包括患者的健康状况、手术方法、术后恢复情况以及对于骨形态、骨水泥固定质量和假体稳定性的判断。结果2例股骨假体发生无菌性松动,臼杯则未见骨溶解或松动征象。未出现骨水泥相关的术中或术后死亡,各类全身性疾病在围手术期无加重表现。41例股骨颈骨折患者术后Harris评分为81．1分。股骨近端骨形态A型17髋(20%),B型47髋(56%),C型20髋(24%)。骨水泥固定质量分别为A级31髋(37%),B级40髋(48%),C级13髋(15%)。结论混合型人工关节置换术的短期随访结果良好；混合型人工关节的术后即时稳定性有利于老年患者的康复；在手术中必须应用现代骨水泥技术。

Objective To examine the performance of the combination of cemented stem non-cemented acetabular cup in order to find out whether the hybrid total hip arthroplasty was preferable for elderly patients with generally declined health status and poor bone quality. Methods Seventy-five patients （84 hips） were followed up, the average age was 67.9 years and the follow-up was 4.1 years. Among the 75 patients, there were 41 elderly patients （41 hips） with acute femoral neck fracture, the average age was 72.1 years. Evaluations of the outcomes of hybrid hip arthroplasty included morphologic feature of bone, quality of cement mantle, implant stability, etc. Results No cement-related death before and after operation was found and systemic diseases did not deteriorate peri-operatively. Radiographic loosening was found in 2 hips on the femoral side, no signs of osteolysis or loosening on the acetabular side. The total Harris Hip Score in patients with femoral neck fracture was 81.1. The bone type was evaluated as Type A in 17 hip （20%）, Type B in 47 （56%） and Type C in 20 （24%）. The quality of cement mantle was evaluated as Grade A in 31 hip （37%）, Grade B in 40 （48%） and Grade C in 13 （15%）. Conclusion Hybrid total hip replacement has good short-term outcome and is preferred in the elderly with acute femoral neck fractures. The immediate postoperative stability enables quicker rehabilitation for elderly patients and lowers the incidence of complications. Contemporary cementing techniques are mandatory in the operation.