金属对金属大直径股骨头全髋关节置换术的近期疗效分析

Short-term results of total hip replacement with metal-on-metal bearings and a large diameter femoral head

目的 探讨金属对金属大直径股骨头全髋关节置换术的特点、手术适应证以及手术操作注意事项,分析其近期疗效.方法 2007年1月至2008年7月对行金属对金属大直径股骨头全髋关节置换术的55例（60髋）患者进行回顾性分析,男30例,女25例 平均年龄48.1岁（18～69岁）.50岁以下33例,占60.0%.双髋同时置换5例,单髋置换50例.术前诊断：股骨头缺血性坏死31例,股骨颈骨折7例,髋关节骨性关节炎12例,强直性脊柱炎5例.所采用的Durom髋臼和MetasulLDH金属对金属大直径股骨头人工髋关节假体均为非骨水泥型. 结果 本组平均手术时间为70min（50～85 min）,失血量平均750 mL（450～1120 mL）,住院时间平均9.6 d（7～12 d）.55例患者术后获3～19个月（平均8.7个月）随访.Harris评分由术前平均41分（15～82分）改善至术后94.7分（91～97分）, 结果 评价均为优.X线片显示假体位置良好,无髋臼和股骨假体松动,均未见异位骨化形成. 结论 全髋关节置换术中使用大直径股骨头能减少术后脱位和关节磨损,并能增加人工关节活动度.金属对金属大直径股骨头全髋关节置换术是年轻、活动度要求高患者的较好选择.

Objective To evaluate the short-term results of total hip replacement with metal-on-metal bearings and a large diameter femoral head. Methods From January 2007 to July 2008, we treated 55 patients （60 hips） with large-diameter metal-on-metal bearings. They were 30 males and 25 females, with an average age of 48.1 years （range, 18 to 69 years）. 60.0% of the patients were younger than 50 years old. Five cases underwent double hip replacement and 50 single hip replacement. The preoperative diagnoses included avascular necrosis of femoral head in 31, femoral neck fracture in 7, hip osteoarthrosis in 12, and ankylosing spondylitis in 5 cases. The Durom acetabulum and Metasul LDH large-diameter metal-on-metal bearings used were of non-cement type. Results For this series, the mean operation time was 70 min （50 to 85 min）, mean blood loss 750 mL （450 to 1120 mL）, and mean hospital stay 9.6 d （7 to 12 d）. All the patients were followed up, with an average duration of 8.7 months （range, 3 to 19 months） . The mean Harris Hip Score improved from the preoperative 41 （15 to 82） to the operative 94. 7 （91 to 97） points. X-ray revealed fine position of the protheses without any loosening. Heterotopic ossification was not observed. Conclusions Metal-on-metal bearings with a large-diameter femoral heads can decrease the risk of dislocations and wear of the joint but increase joint range of motion. It is a good choice for young and active patients.