股骨颈骨折人工股骨头置换术后髋臼磨损的测量及其临床意义

Measurement of Acetabular Wear and Its Clinical Significance in Artificial Femoral Head Replacement

目的以计算机数字化方法测量人工股骨头假体置换术后髋臼的磨损,并探讨磨损程度与临床症状的相关性。方法对84例人工股骨头置换术后的病例进行随访。利用计算机测量股骨头中心相对于髋臼中心的矢量位移,进行临床检查、磨损计量和放射学检查。结果本组随访1～6年,平均3.8年。最常见的问题是髋臼臼底机械磨损引起的疼痛。根据Merled’Aubign啨评分法,优或良21例,中25例,差58例。平均线性磨损为4.03mm,磨损率为1.06mm/年。结论在进行临床随访、放射学观察的同时,磨损情况也是全面评价人工股骨头置换临床结果的一个重要指标,对股骨颈骨折患者的关节置换以选择全髋关节置换为宜。

Objective To measure the acetabular wear with a computer - assisted two - dimensional method, and to evaluate the relationship between wear and the long term clinic radiological findings. Methods Eighty- four patients undergoing the artificial femoral head replacement were examined. The linear acetabular wear was measured. The migration in the femoral head center relative to the cup shell center was calculated on the digitized consecutive radiographs with a special computer soft ware program. The degree and direction of wear were also determined, and the radiographs of 84 artificial femoral head replacements were examined for the radiolucent line, the osteolysis and the femoral head migration. Results The patients were followed up for an average period of 3.8 year. The most essential problem causing hip pain was the mechanical wear in acetabulum （78 % ）. Based on Merle d＇ Aubign6e evaluation system, 21 patients had excellent results, 25 patients good and 58 patients poor results. The average linear wear was 4.03 mm. The wear rate was 1.06 mm every year. Conclusion. The acetabular wear is an important index in evaluating the clinical and radiological outcomes of artificial femoral head replacement. It also suggests that total hip arthroplasty may be better than the femoral head replacement for patients with femoral neck fracture in relatively young patients.