应用金属对金属全髋表面置换术的早期疗效及临床体会

Short-term result and clinical comprehension on application of metal on metal surface replacement of hip

[目的]探讨金属对金属人工全髋表面置换术（MMSA）的早期疗效及临床体会，指导临床规范、合理的应用该技术。[方法]从2004年9月～2005年7月，对18例（23髋）患者行混合型MMSA术（Conserve Plus，Wright），其中股骨头坏死12例、骨性关节炎3例、先天性髋关节发育不良2例和创伤后骨性关节炎1例。平均年龄43岁（28～54岁），平均体重指数（RMI）27．3（20．5～44．8）。对所有患者都进行了问卷调查、髋关节功能检查、并做了术前、术后的Harris评分，术后疼痛发生评估及x线分析等。[结果]所有患者均获得随访，平均随访17．8个月（14～24个月）。23个患髋的Harris髋关节评分平均从术前46（32～51）分到术后1年的85（58～96）分，最后一次随访时为93（61～100）分。2例术后轻微疼痛，1例中度疼痛（Charnley C组），无严重疼痛报告。X线显示：1例股骨假体内翻成角10°，但随访过程中没有出现假体松动和股骨颈骨折的并发症。所有病例未发现有股骨颈狭窄、股骨头坏死及假体固定失败等并发症。[结论]作为THR术前的过渡性术式，MMSA术为治疗年轻的或术后对活动量要求较高的年老髋关节疾病患者提供了一种新的有价值的手术方法。其早期疗效令人满意，但中、长期临床结果仍需进一步研究。

[Objective] To approach the short-term result of metal on metal surface arthroplasty （MMSA） and clinical comprehension to direct its standard and reasonable application clinically. [Method] From September, 2004 to July, 2005, 23 hips in 18 patients were treated with hybrid prothesis of MMSA （Conserve Plus, Wright） including 13 case of osteonecrosis （ON）, 3 cases of osteoarthritis （OA）, 1 cases of developmental dysplasia of the hip （DDH） and 1 case of posterior trauma arthritis （PTA）. The mean age was 43 years （28～54 years） and the average RMI was 27.3 （20.5～44.8）. All patients were evaluated by self assessment form, hip function examination, radiographs, occurrence of pain, preoperative and postoperative Harris hip score. [Result] All patients obtained the follow-up and the average time was 17.8 months （14～24）. The Harris score rose from preoperative 46 （32～51） to 85 （58～96） at one year after the operation to 93 （61～100） at the latest follow-up. Of 16 hips, 2 hips had mild pain, 1 hip （Charnley C） had moderate pain, and no patients reported marked pain. Further, 1 femoral components had introversion angulation of 10°, but prosthesis loosening and fractures of femoral neck had not happened at the latest follow-up. There was no occurance of complications such as femoral neck narrowing, osteonecrosis and failure of fixiation etc in all patients. [Conclusion] As a transitional operation before applying the total hip replacement （THR）, MMSA offers a newly valuable technology for treatment of young patients or the elderly patients with the higher requirement of movement after the operation. Its short-term result is satisfactory, but the medium and long-term effection still need the further research.