金属对金属全髋表面置换术的操作要点与早期疗效

Technical key points and short-term results of metal on metal resurface replacement of hip

目的介绍金属对金属人工全髋表面置换术的操作要点与早期疗效。方法从2004年9月～2006年12月,对28例(35髋)患者行混合型金属人工全髋表面置换术(Conserve Plus,Wright),其中股骨头缺血性坏死16例、骨性关节炎5例、先天性髋关节发育不良4例和创伤性关节炎3例。平均年龄42岁(28～54岁),平均体重指数(RMI)27.3(20.5～44.8)。对所有患者均进行问卷调查、髋关节功能检查、术前术后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18个月(6～30个月)。25例Harris评分从术前平均40(32～51)分提高到术后93(75～97)分。2例术后轻微疼痛,1例中度疼痛,无严重疼痛。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。该手术的操作要点为准确的股骨颈中心定位;切忌股骨颈切迹的发生;股骨头病灶的清理必须干净彻底,决不姑息;股骨侧假体不应内翻位植入及增加股骨头高度;臼杯的安装必须真正紧密压配。结论金属对金属全髋关节表面置换术是治疗股骨头缺血性坏死、骨关节炎、髋发育不良等年轻患者及大运动量患者的过渡性手术,近期随访结果满意。但该术式技术要求高,如不掌握要点极易产生并发症。

Objective To introduce the technical key points and short-term results of metal on metal surface arthroplasty （MMSA）of hip. Methods From September, 2004 to December, 2006, 35 hips in 28 patients were treated with hybrid prothesis of MMSA （Conserve Plus, Wright） including 16 case of osteonecrosis（ON）, 5 cases of osteoarthritis （OA）, 3 cases of developmental dysplasia of the hip （DDH） and 2 case of posterior traumaarthritis （PTA）. The mean age was 42 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. Results All patients obtained the follow-up and the average time was 18 months （6-30）. The Harris score rose from preoperative 40 （32-51 ） to 93 （75-97） postoperatively. 2 hips had mild pain, 1 hip had moderate pain, and no patients reported marked pain after operation. Further, 1 femoral components had varus angle of 10°, but no prosthesis loosening and femoral neck fracture. There was no complications such as femoral neck narrowing, osteonecrosis and failure of fixiation etc in all patients. Several key points will be mastered in this surgery, for example the precise location of the femoral head center, avoiding the incisure of femoral neck, eliminating the focus of the femoral head complitily, avoiding the femoral implant in varus and improving the height of the femoral head, making surely the cap of the acetabulum inseparably fixed. Condusions The metal on metal surface arthroplasty is a best transitional solution for the young patients with osteonecrosis of the femoral head, osteoarthritis, hip dyplasia, who need high strength activities. The short-term results are satisfied. But it is easy to lead to complications if do not master technical key points, because the surgery request high techniques.