应用羟基磷灰石喷涂解剖型股骨假体的中期随访结果

Medium-term results of a hydroxyapatite-coated anatomic stem primary total hip arthroplasty

目的探讨使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术的中期随访结果。方法对2001年1月至2003年12月使用羟基磷灰石喷涂解剖型股骨假体的全髋关节置换术患者75例90髋进行中期随访，男49例61髋，女26例29髋；患者年龄42-68岁，平均58．4岁。以HaMs评分系统进行临床结果评估，采用配对t检验分别比较末次随访Harris评分与术前Harris评分、术后早期Haris评分之间的差异；拍摄髋关节正、侧位X线片对影像学结果进行评估。结果48例56髋获得随访，男29例35髋，女19例21髋；随访时间5-8年，平均7．2年。随访中无翻修病例。术前HaMs评分平均（28．2±6．3）分，术后早期（平均1年）平均（93．2±4．8）分，末次随访平均（91．6±4．5）分，优良率100％。末次随访HaMs评分与术前比较差异有统计学意义（P〈0．05），与术后早期比较差异无统计学意义（P〉0．05）。随访期间出现大腿痛3例。X线片显示全部假体均获得稳定的骨长人，出现股骨近端局限性骨溶解2例、似体柄远端骨质硬化3例、假体周围间断透光线6例，无一例出现假体下沉和假体内外翻。结论羟基磷灰石喷涂解剖型股骨假体应用于全髋关节置换术的中期随访结果满意，假体可以获得稳定的骨长入，但远期疗效有待进一步观察。

Objective To observe the clinical and radiographic outcomes following the THA using a hydroxyapatite-coated anatomic stem. Methods From 2001 to 2003, 90 total hip arthroplasty were performed in 75 patients using a hydroxyapatite-coated anatomic stem. There are 49 males and 26 females, with the mean age of 58.4 years, range from 42 to 68 years. The mean follow-up period was 7.2 years （5 to 8 years）. All patients were evaluated clinically using Harris hip score; preoperative and follow-up radiographs were made. Results Forty-eight patients with 56 hips were involved in this study. There were 29 males and 19 females were included. No patients had underwent revision arthroplasty or aseptic loosening. Accord- ing to the Harris hip score, the average hip score increased from 28.2±6.3 before operation to 93.2±4.8 one year after operation and to 91.6±4.5 at the final review. There was significant difference between the Harris scores at final review and preoperative ones, but no difference one year after operation. All patients had excellent or good results. Three cases were found to be associated with thigh pain. All prostheses were well osseointegrated. Limited proximal femoral osteolysis occurred in two cases, three cases had radiographic evidence of osteosclerosis on the tip of the stem, and six cases were found to represent discontinuous radiolucent lines surrounding the stem on the radiographs. No stem subsidence and varus/valgus happened. Con- clusion Hydroxyapatite-coated anatomic stem provided favorable clinical and radiographic results after an intermediate duration of follow-up. The prosthesis had achieved reliable bone ingrowths. The long-term results is needed to be confirmed in future.