第四代金属-金属表面髋关节置换假体的临床应用

Clinical Application of Generation IV Metal-metal Surface Hip Replacement Prosthesis

目的探讨第四代金属-金属表面髋关节置换假体(ASR)的临床应用效果。方法选择我院2007年1月—2008年3月收治的股骨头缺血性坏死(27例)和髋关节骨性关节炎(15例)患者为研究对象。根据术前X线影像学评估,术中股骨头形态处理较好的20例(23髋)患者作为ASR组,其余22例(24髋)患者作为XL-ASR组,分别行金属-金属髋关节表面置换和大头全髋关节置换。假体采用Depuy公司生产的第四代金属-金属表面髋关节置换假体(ASR)及大头全髋关节置换系统(XL-ASR),两组平均随访1年以上并进行临床对照。比较两组患者手术前后髋关节Harris评分、髋关节活动范围(ROM)、股骨偏心距、双下肢不等长差值、手术切口、手术时间等指标。结果(1)术前ASR组和XL-ASR组髋关节Harris评分分别为(56±18)分和(54±22)分,差异无统计学意义(P>0.05);术后分别为(92±18)分和(92±20)分,差异无统计学意义(P>0.05)。(2)治疗后ASR组优10例,良6例,可4例,差0例;XL-ASR组优12例,良8例,可2例,差0例,两组疗效间差异无统计学意义(P>0.05)。(3)随访1年,ASR组和XL-ASR组髋关节ROM提高的度数分别为(33.1±2.2)°和(34.8±3.1)°,差异无统计学意义(P=0.507);但术后6个月ASR组ROM提高的度数显著高于XL-ASR组〔(37.7±2.3)°和(29.3±3.2)°,P=0.008〕。(4)ASR组股骨偏距、双下肢不等长差值、手术切口、手术时间分别为(-3.1±4.7)mm、(3.3±3.1)mm、(14.4±3.0)cm和(120±20)min;XL-ASR组分别为(5.7±9.1)mm、(6.7±4.6)mm、(11.3±2.6)cm和(70±14)min,差异均有统计学意义(P<0.05)。结论ASR治疗年轻及活动量较大患者早期随访结果较好,术后获得了较好的髋关节功能并恢复髋关节的生物力学,保留了骨量。但与XL-ASR比较,ASR手术的操作难度大、手术创伤大、操作时间长。

Objective To discuss the application of Generation Ⅳ metal - metal surface hip replacement prosthesis. Methods Femoral head avascular necrosis patients （ n = 27 ） and hip osteoarthritis （ n = 15 ） admitted to our hospital from January 2007 to March 2008 were enrolled in this study. Based on pre -operative X -ray imaging, 20 patients （23 hips） with better - managed femoral heads were chosen as ASR group receiving metal - metal hip surface replacement, the other 22 patients （ 24 hips） as XL - ASR group receiving total hip replacement. Both groups were followed up more than 1 year. Pre - and post - operative Harris hip score and hip range of movement （ROM） , hip eccentricity, leg - length inequality, operative incision and operation time, etc. were compared in 2 groups. Results The Harris scores of groups ASR and XL - ASR were 56 ± 18, 54 ±22, respectively, before operation, the difference was not significant （ P 〉 0. 05 ） ; and 92 ±18, 92 ±20, respectively, after operation, the difference was not significant （P 〉0. 05）. After treatment excellent effect was noted in 10 patients, good in 6, normal in 4 and bad in 0 in AST group, and 12, 8, 2, 0, respectively, in XL -ASR group, the difference was not significant （P 〉 0.05 ）. After 1 -year follow up, no significant difference was found in ROM improvement between groups ASR 33.1 ±2.2°and XL - ASR 34. 8 ±3.1° （ P = 0. 507 ） ; but ROM was significantly higher in ASR group （ 37. 7 ±2. 3 ） than in XL - ASR group （29.3± 3.2） （ P = 0. 008 ）. The hip eccentricity, leg - length inequality, operative insions and operative time were - 3. 1 ± 4.7mm, 3.3 ±3. 1 mm, 14.4 ±3.0 cm, 120 ±20 min, respectively, in AST group, and 5.7 ±9. 1 mm, 6.7 ±4.6 mm, 11.3 ± 2. 6 cm, 70 ± 14 min, respectively, in XL - ASR group, the difference was significant （ P 〈 0.05 ）. Conclusion ASR, gaining better hip functions and regaining hip biomechanics and keeping the bone mass after operation, gives better early follow - up results to young patients or those with more activity amount. But ASR is difficult to handle, with larger incisions and longer time, as compared with XL - ASR.