陶瓷-陶瓷全髋关节置换术中困难及对策

Ceramic-on-ceramic total hip arthroplasty:Pitfalls and strategy

目的分析陶瓷-陶瓷全髋关节置换术中可能出现的困难,研究避免其出现的对策。方法2001年9月至2007年12月,我院共施行1019例陶瓷-陶瓷全髋关节置换术,其中男性585例,女性434例,平均年龄59.5岁(39～76岁);采用Stryker陶瓷-陶瓷全髋关节362例,普鲁斯陶瓷-陶瓷全髋关节544例,Lima陶瓷-陶瓷全髋关节(三明治型)113例;术前诊断显示股骨头缺血性坏死314例,发育性髋关节脱位268例,骨关节炎194例,强直性脊柱炎74例,类风湿性关节炎107例,股骨颈骨折GardenⅣ型62例。结果术中出现的技术性困难,包括术中因关节稳定性不佳,需要调整髋臼杯位置34例;置放陶瓷内衬不当,需要取出重新安装19例;髋臼内衬置放时碎裂3例;截骨位置过低造成超过0.5 cm肢体短缩31例。结论针对陶瓷-陶瓷全髋关节置换术假体材料的特性,在手术操作技术上做出相应的调整,可避免可能会出现的困难。

Objective To analyze the pitfalls in ceramic-on-ceramic total hip arthroplasy(THA),and find the way to avoid the complications.Methods From September 2001 to December 2007,we operated on 1019 hips with ceramic-on-ceramic total hip prosthesis in our department.The patients included male 585 and female 434,mean age 59.5(range 39-76).Prosthesis used includ 362 Trident cups & Secur-fit Max stems(Stryker),544 EP-fit Plus cups & SL-Plus stems(Plus Orthopedics) and 113 SPH cups & C2 stems(Lima,sandwich type).Preoperative diagnosis include femoral head avascular necrosis(314 cases), developmental dysplasia(dislocation) of the hip(268 cases),osteoarthritis(194 cases),ankylosing spondylitis(74 cases), rheumatoid arthritis(107 cases),and femoral neck fracture(GardenⅣ,62 cases).Results Cup position was adjusted in 34 cases because of hip instability during intra-operative test.Ceramic liners were replanted in 19 cases.There were 3 ceramic liner chipping and leg length shortening more than 0.5 cm in 31 cases.Conclusion To avoid complications,special technique should be learned while using ceramic-to-ceramic total hip prosthesis.