大直径金属对金属假体与传统假体全髋关节置换术的早期疗效比较

Comparative study on early clinical effect between large-diameter metal-on-metal prosthesis and tra. ditional prosthesis in total hip replacement

目的总结大直径金属对金属假体全髋关节置换术的早期临床疗效。方法回顾性分析2006年5月至2008年12月应用大直径金属对金属假体与传统28mm直径假体的全髋关节置换术各58例（58髋）患者的临床资料。大直径金属对金属假体组男32例，女26例；年龄30-75岁，平均54．1岁；传统28mm直径假体组男34例，女24例；年龄32-76岁，平均55．8岁。两组患者性别、年龄、体重、术前诊断、术前疼痛发生率、关节活动范围、Harris评分无统计学差异。传统28mm直径假体髋臼用两枚螺钉固定，大直径金属对金属无内衬髋臼靠压配获得初始固定。结果全部患者随访6～35个月，平均23．6个月。（1）大直径金属对金属假体组术后Harris评分平均97分，优良率96．6％；传统28mm直径假体组平均88分，优良率89．7％。两组优良率差异有统计学意义。（2）大直径金属对金属假体组髋关节周围疼痛2例（3-4％），传统28mm直径假体组8例（13．8％）。（3）大直径金属对金属假体组无假体脱位，传统28mm直径假体组脱位1例。（4）术后大直径金属对金属假体组髋关节总活动范围大于140°者52髋，平均240°；传统28mm直径假体组大于140°者46例，平均190°。平均活动范围的差异有统计学意义。结论大直径金属对金属全髋关节与传统28mm直径全髋关节比较具有更好的早期稳定性和关节活动功能，疼痛发生率低。

Objective To summary the early follow-up effect of primary total hip arthroplasty CYHA） between large diameter metal-on-metal（MOM）. Methods From May 2006 to December 2008, 58 cases were treated with large diameter MOM prosthesis, which included 32 males and 26 females, with the mean age of 54.1 years, and the other 58 patients were treated with traditional 28 ram-diameter, which included 34 males and 24 females, with the mean age of 55.8 years. The gender, age, body weight, preoperative diagnosis, Harris scores, pain around the joint and the motion range of hip joint had no difference. The traditional prosthesis was fixed by two screws; while MOM prosthesis got the primary stability by compress. Results All patients were followed up 6-35 months, with the average time of 23.6 months. 1） The average Harris scores was 97 for MOM group postoperatively （rate of excellent was 96.6%）; while 88 for traditional prosthesis group （89.7%）. 2） The morbidity of pain around the joint was found in 2 cases for MOM group postoperatively （3.4%）; while 8 cases for traditional prosthesis group （13.8%）. 3） In the traditional prosthesis group, there was 1 cases of dislocation, while none in the other group. 4） In above 140° total motion range of hip joint, the MOM articulation group had 52 cases, with 240° total average motion range of hip joint; the traditional prosthesis group had 46 cases, with 190° total average ,notion range of hip joint（P〈0.05）. Conclusion The early effect of large diameter MOM THA was better than that of traditional prosthesis THA, and with better joint stability and function and lower pain around hip joint.