一种新的短柄髋关节假体置换21例近期临床疗效分析(英文)

The little master-results of proxima hip replacement

[目的]全髋关节置换术(THR)治疗老年股骨头坏死已取得良好疗效,但对于年轻患者来说,若实施THR手术必须保留更多的骨与软组织,否则远期会导致灾难性后果。传统的长柄髋关节假体切除范围大,不利于术后功能恢复。为此,本文介绍一种全新的短柄髋关节假体,并对其近期临床疗效进行分析。[方法]2006年7月～2008年3月,21例(29髋)患者接受了短柄髋关节假体置换术。手术时平均44岁。其中8例患者行双侧关节置换。假体采用更大直径金属对金属股骨头。术中保留全部股骨颈和转子间肌肉软组织。术后平均随访1年,所有患者行X线和临床检查、Harris评估、以及髋关节功能改善程度和患者满意率调查。[结果]平均Harris评分由术前48分提高至术后88分。术后3～4个月所有患者可以全负重行走。1例术中骨折,术后愈合,未留后遗症。1例术后持续疼痛,原因不明,其他功能恢复正常。1例术后9个月无菌性松动,行再次返修。所有病例未发现髋臼杯松动或移位。[结论]本组病例近期临床效果满意,更多的保留股骨颈和肌肉组织可为术后提供更好的正常生理负载,帮助关节重新塑形。全新的短柄髋关节假体符合生物力学原理,具有发展前景。

[ Objective] Total hip replacement has given good results in ＂the elderly population but with an increasing number of younger patients requiring hip replacement, soft tissue and bone preservation has become important. Studies have shown that a more natural loading of the proximal femur leads to preservation of bone stock and aids remodeling. Proxima hip was developed keeping these requirements in mind. [ Methods ] Twenty nine Proxima hip replacements were performed on twenty one patients between July 2006 and March 2008 by the senior author. The average age of the patients at the time of surgery was 44 years. Eight of the patients had bilateral hip replacement in the same sitting. The implant used was a Proxima stem with a large diameter metal on metal XL head. Particular care was taken in preserving the full length of femoral neck and the trochanteric muscles. The patients were assessed by Harris hip score, return to normal and advanced hip functions and satisfaction levels. All patients were followed up with serial X rays and clinical examination. [ Results] Average duration of follow up was 1 year. The mean Harris hip score pre surgery was 48 and at last follow up was 88. All patients at 3 to 4 months achieved full weight bearing. One patient had an intra - operation fracture of the lateral cortex which recovered without any sequelae. Another patient had persistent thigh pain without any apparent cause and a poor result. One stem was revised because of aseptic loosening after 9 months. None of the hips showed any sign of acetabular cup loosening or migration. [ Conclusions] Early results in this young group of patients are very encouraging. This small implant relies on the preserved neck and the lateral flare for its stability, ensuring a more natural loading of the proximal femur and preserving bone stock and facilitating remodeling. As our results show the Proxima stem as an implant that stands the test of biomechanics and holds a promising future.