老年患者人工骨水泥型与非骨水泥型全髋关节置换后假体稳定性及髋关节功能比较

Comparison of postoperative prosthesis stability and hip joint function following cemented versus cementless total hip arthroplasty in elderly patients

选择1999-01/2002-01重庆医科大学第二附属医院骨科行初次全髋置换获得完整随访资料40例老年髋部疾患患者。骨水泥组16例,非骨水泥组24例。置换后下地时间骨水泥组明显短于非骨水泥组(P<0.05)。骨水泥组1例患者发生骨水泥外漏,对关节功能无影响;非骨水泥组1例发生股骨近端线形骨折,以钢丝环扎固定并最终愈合,1例出现与牵拉有关的坐骨神经损伤,保守治疗2个月后恢复,1例髋关节发生脱位,予手法闭合复位成功。2例骨水泥柄在骨-水泥界面和1例非骨水泥柄在骨-假体界面出现小于2mm的透亮线,1例非骨水泥柄在Gruen7区出现局灶性骨溶解,每组各有两个臼杯在Delee1区出现局灶性骨溶解,两组假体周围透亮线的发生率差异无显著性(P=0.08)。所有X射线片显示假体无移位、松动及下沉。

Forty patients with hip disease who underwent first total hip arthroplasty （THA） in Department of Orthopedics, Second Hospital of Chongqing Medical University from January 1999 to January 2002 were selected. They were treated with cemented （n =16） and cementless THA （n =24）. The time to leave bed of cemented-THA group was obviously shortened compared with cementless THA group （P 〈 0.05）. One patient developed cement leakage, but the joint function did not affected. In cementless THA group, one patient developed linear fracture in proximal femur, and cured by fixation with steel-wire ring; one developed sciatic nerve injury caused by traction and recovered after 2 months of conservative treatment; one developed hip joint dislocation and recovered using manually closed reduction. Radiolucent lines 〈 2 mm were found in bone-prosthesis interface of 2 cases in cemented group and 1 case in cementless THA group. Focal osteolysis occurred in Grumen 7 region of cementless stem of one case. In addition, focal osteolysis was found in Delee 1 region of one case in each group. The prevalence of radiolucent lines around the prosthesis was not significantly different between two groups （P =0.08）. Radiographs show no prosthesis displacement, loosening or subsidence.