金对金解剖直径头微创全髋关节置换术治疗高龄股骨颈骨折的近期疗效对照研究

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

目的探讨金对金解剖直径头和常规小直径头(28mm)全髋关节置换(total hip arthroplasty,THA)微创技术治疗高龄股骨颈骨折患者的临床疗效。方法 2006年1月至2007年12月间因股骨颈骨折在我中心行微创全髋关节置换手术并获得完整资料的高龄(>70岁)患者61例61髋,其中采用常规直径头股骨头全髋关节假体(对照组)30例30髋,采用金对金大直径股骨头全髋关节假体(观察组)31例31髋。分析两组术后2周、6周髋关节活动范围,术后2年假体脱位率以及Harris评分结果的差异。结果术后对照组脱位2例6次,观察组0例。观察组的Harris评分优秀率高于对照组;术后2周(除后伸动作外)和6周的髋关节活动度均大于对照组,两组比较,差异有统计学意义(P<0.05)。结论采用金对金解剖直径头THA微创技术治疗高龄股骨颈骨折患者,具有术后早期髋关节稳定性提高、主动活动范围增加、术后脱位率降低等优点,近期疗效满意。

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty （THA） using metal-on-metal large-diameter and conventional diameter femoral head for the elderly patients with femoral neck fractures. Method From January 2006 to December 2007, 61 elderly patients （70 years old） with 61 hips obtained minimally invasive THA for femoral neck fractures in our center. Those patients were divided into the control group （30 cases 30 hips with THA using standard 28 mm diameter femoral head） and the experimental group （31 cases 31 hips with THA using metal-on-metal large-diameter femoral head）. The range of motion of hip at 2 and 6 weeks after operation, the prothesis dislocation rate and Harris score after 2 years＇ follow-up were compared between two groups. Results In control group, dislocation occurred in 2 cases for 6 times while no dislocation happened in experimental group. Compared with control group, the excellent rate of Harris score was higher and the range of motion of hip at 2 weeks（except posterior extension） and 6 weeks after operation were better. There was statistically difference between two groups （P 0.05）. Conclusion Minimally invasive THA with metal-on-metal large diameter femoral head prothesis has been proved to obtain satisfactory short-term curative effects which could improve the stability of hip during early postoperative period, increase the range of active motion and reduce the incidence of postoperative dislocation.