陶瓷-陶瓷人工髋关节行中青年人工全髋关节置换疗效分析

EFFICACY OF CERAMIC ON CERAMIC HIP PROSTHESIS IN YOUNG PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY

目的探讨采用陶瓷-陶瓷人工髋关节行中青年人工全髋关节置换的方法及疗效。方法回顾分析2004年2月-2006年9月65例75髋行陶瓷-陶瓷人工髋关节置换患者的临床资料。男41例,女24例;年龄18～56岁,平均43.2岁。股骨头粉碎性骨折6例,股骨头无菌性坏死44例,髋关节发育不良伴髋关节骨性关节炎7例,先天性髋关节脱位3例,髋臼骨折术后创伤性关节炎2例,双侧髋关节类风湿性关节炎1例,强直性脊柱炎2例。单髋置换55例,双髋置换10例。术前Harris评分为(54.3±6.7)分。患者病程为1年4个月～10年7个月,平均3年2个月。结果术后切口均Ⅰ期愈合,无脱位、下肢深静脉血栓等并发症发生。患者均获随访,随访时间3年2个月～5年7个月,平均4年9个月。术后1例出现人工髋关节异响,12例髋关节周围异位骨化,5例轻度跛行,均未作特殊处理。末次随访时,Harris评分为(89.0±9.4)分,与术前比较差异有统计学意义(P<0.01)。影像学检查示,髋臼侧假体外翻角为(43.6±8.4)°,前倾角为(21.5±3.5)°。随访期间未见假体松动、下沉、移位及碎裂发生,假体周围无透亮线形成。患者均恢复日常生活。结论陶瓷-陶瓷人工髋关节置换治疗中青年髋关节疾患能有效减少因关节界面磨损导致的人工髋关节松动、下沉等并发症,提高手术技术能有效避免或减少陶瓷-陶瓷人工髋关节易脱位、易碎裂等并发症的发生。

Objective To investigate the methodology and efficacy evaluation of ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients. Methods The clinical data from 65 patients （75 hips） who received ceramic on ceramic hip prosthesis for total hip arthroplasty between February 2004 and September 2006, including unilateral replacement in 55 cases and bilateral replacement in 10 cases. Of 65 patients, there were 41 males and 24 females with an average age of 43.2 years （range, 18-56 years）, including 6 cases of femoral head comminuted fractures, 44 cases of aseptic necrosis femoral head, 7 cases of developmental dysplasia of hip with osteoarthritis, 3 cases of congenital dislocation of hip, 2 cases of traumatic arthritis secondary to postoperative acetabulum fracture, 1 case of rheumatoid arthritis, and 2 cases of ankylosing spondylitis. The Harris score was 54.3 4. 6.7. The disease duration was 1 year and 4 months to 10 years and 7 months with an average of 3 years and 2 months. Results Healing of incision by first intention was achieved in all patients; no dislocation, infection, and deep venous thrombosis of lower limbs occurred. All patients were followed up 3 years and 2 months to 5 years and 7 months with an average of 4 years and 9 months. The Harris score was significantly improved to 89.0 4. 9.4 at last follow-up, showing significant difference when compared with preoperative one （P 〈 0.01）. The mean eversion angle and anteversion angle of the acetabular component were （43.6 ± 8.4）° and （21.5 ± 3.5）°, respectively. In follow-up period, no prosthetic loosening, subsidence, dislocation, and ceramic component fracture occurred. Osteolysis was not found in all the cases. Conclusion Ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients can effectively decrease the complications of prosthetic loosening and subsidence caused by wearing of joint interface; the surgical skill is important in decreasing dislocation and fraction of ceramic on ceramic hi p prosthesis.