非骨水泥全髋关节置换术治疗股骨头缺血性坏死的疗效观察

Cementless total hip arthroplasty in patients with avascular necrosis of the femoral head

[目的]对使用非骨水泥全髋关节置换术治疗股骨头缺血性坏死的患者进行临床及影像学随访，探讨其疗效、并发症及其影响因素。[方法]选取2000年3月-2007年11月以来因股骨头缺血性坏死在本院行非骨水泥全髋关节置换术并具有完整临床及影像资料的76例（91髋）患者进行随访。临床随访包括术前术后Harris评分及各种并发症。影像学评估包括双侧髋关节正位、患髋侧位片，判断股骨及髋臼假体的位置及其周围骨质的变化，并测量髋臼内衬线性磨损量。[结果]截至末次随访时，68例（82髋）获得随访，随访率为90．1％，随访时间平均为48．8个月。术前Harris评分平均为42分（5～86分），末次随访时为93分（53～99分），优良率为90．2％。术后1例患者发生与活动相关的大腿痛，影像学上9髋股骨假体发生早期不稳定，14髋发生应力遮挡，5髋发生异位骨化。无假体松动或翻修病例。[结论]非骨水泥全髋关节置换术治疗晚期股骨头缺血性坏死疗效确切，但存在一过性大腿痛、应力遮挡、异位骨化、假体磨损等并发症，故需长期随访。

[ Objective]To evaluate the clinical and radiographic results of cementless total hip arthroplasty（THA） in patients with avascular necrosis of the femoral head（AVNFH）. [ Method ] A series of 76 patients （91 hips） with AVNFH who had undergone cementless THA since 2000 were involved in this study. Eighty-two hips in 68 patients （90.1% ） were available for this review. The mean follow-up time was 48.8 months （range ,25 - 108 months）. Clinical outcomes were evaluated based on the Harris score. Components migration ,bone remodeling around the implant and polyethylene wear were assessed in the anteriorposte- riot and lateral X-ray of the hips. [ Result] The average Harris score improved from 42 preoperatively to 93 postoperatively. One patient suffered from thigh pain at the final follow-up. Stress shielding and ectopic ossification were observed in 14 hips and 5 hips, respectively. No radiographic loosening and revision occurred. [ Conclusion] Cementless THA in patients with AVNFH had satisfactory clinical and radiographic outcomes. Complications, such as stress shielding, ectopic ossification, and polyethylene wear cannot be avoided. With the developing of the surgical technique, improvement of the material and design of the implant, these complications will be reduced, but a long-term further follow-up is still necessary.