比较人工全髋关节置换在治疗股骨头缺血性坏死和类风湿性关节炎中的作用

Comparison of total hip arthroplasty in avascular necrosis of the femoral head and rheumatoid arthritis

目的评估人工全髋关节置换(THA)在治疗股骨头缺血性坏死(AVN)和类风湿性关节炎(RA)中的作用。方法采用非骨水泥型THA治疗的42例(50髋)AVN和40例(50髋)RA患者,分别进行临床和影像学比较。临床随访包括Harris评分、术后翻修率和并发症分析;影像学评估包括骨溶解、聚乙烯臼杯磨损率分析。结果患者均获随访,时间5～10年。临床随访结果:AVN组和RA组Harris评分由术前(49.59±9.03)分和(48.76±7.61)分,术后分别提高到(90.76±5.64)分和(87.18±6.83)分,较术前均明显提高,但两组间Harris分值提高差异无统计学意义(P>0.05);AVN组和RA组术后翻修率分别为6%(3髋)和8%(4髋),并发症分别为6%(3髋)和10%(5髋),两组间差异无显著性(P>0.05)。影像学结果:聚乙烯磨损率AVN组明显高于RA组,分别为(0.15±0.11)mm/年和(0.10±0.09)mm/年,两组比较差异有统计学意义(P<0.05);髋臼侧骨溶解发生率AVN组明显高于RA组,分别为18%(9髋)和4%(2髋),两组比较差异有统计学意义(P<0.05);而股骨侧假体骨溶解发生率分别为20%和12%,两组比较差异无统计学意义(P>0.05)。结论非骨水泥型THA在AVN和RA随访中均取得了良好的疗效,但AVN组髋臼侧聚乙烯内衬磨损和髋臼骨溶解高于RA组。

Objective To evaluate the midterm clinical and radiographic outcomes of primary total hip arthroplasty （THA） in avascular necrosis （AVN） of the femoral head and rheumatoid arthritis （RA）.Methods 42 patients （50 hips） with AVN and 40 patients （50 hips） with RA were performed cementless total hip arthroplasty.All the patients were followed up.The results of each group were evaluated through the clinical and radiographic methods.The clinical assessments included Harris Hip score （HHS）,complications and revision analysis.And radiographic evaluation included osteolysis,polyethylene wear and cup/stem loosening.Results The follow up time was 510 years.The mean preoperative HHS was （49.59±9.03） as opposed to a postoperative HHS of （90.76±5.64） in AVN group,and the average HHS was improved from （48.76±7.61） to （87.18±6.83） at final follow-up in RA group.The revision rate was 6% （3 hips） in AVN group and 8% （4 hips） in RA group.The incidence of complication was 6% （3 hips） in AVN group and 10% （5 hips） in RA group.There was no significant difference between AVN group and RA group.Radiographic analysis of all hips showed that polyethylene wear was （0.15±0.11） mm/y in AVN group and （0.10±0.09） mm/y in RA group,the polyethylene wear of AVN group was higher than RA group.There was significant difference between two groups （P〈0.05）.Acetabular osteolysis occurred in 9 hips （18%） with AVN and 2 hips （4%） with RA,the acetabular osteolysis of AVN group was higher than RA group.There was significant difference between two groups （P〈0.05）.The femoral osteolysis was no different between the two groups（20%,12%,P〉0.05）.Conclusions Cementless total hip arthroplasty in AVN and RA can provide favorable result in midterm with significant improvement of HHS in both. THA in AVN group is associated with higher incidence of polyethylene wear liner wear and higher rate of periprosthetic osteolysis compared with RA group.Cementless total hip arthroplasty is an effective tool for both stage of AVN of femoral head and RA.