大直径金属对金属与陶瓷对陶瓷全髋置换术的手术体会及近期疗效比较

Short-term comparison and operative experience of metal-on-metal versus ceramic-on-ceramic bearing surfaces in total hip arthroplasty

[目的]探讨大直径金属对金属（MOM）和陶瓷对陶瓷（COC）全髋置换术的手术体会及近期疗效。[方法]2009年4月～2010年1月，采用大直径MOM行全髋置换20例20髋，患者平均年龄（51．7±3．8）岁，平均体重指数（23．3±2．1）kg／m^2，术后随访（13±2）个月。采用COC行全髋置换19例20髋，患者平均年龄（53．1±2．9）岁，平均体重指数（23．8±2．6）kg／m^2，术后随访（15±2）个月。通过临床（Harris评分）和x线观察，对两组患者术后功能和影像学进行对比研究。[结果]本组无1例感染、骨折、脱位，无1例深静脉血栓及神经损伤等并发症。临床随访：两组术前Harris评分差异无统计学意义（P〉0．05），术后6周、3、6、t2个月Harris评分差异具有统计学意义（P〈0．05）。MOM组术后6个月大腿痛弱痛1例，无中、重度疼痛，COC组无1例大腿痛。术后1年MOM组髋关节总活动范围228．35°±9．72°，COC组髋关节总活动范围191．15°±10．59°，差异具有统计学意义（P〈0．05）。X线随访：39髋（97．5％）股骨假体位于中立位，1髋（2．5％）轻度外翻位，MOM组无1例股骨假体下沉，COC组术后6个月4髋出现〈1．5mm的下沉，末次随访股骨假体位置无改变。MOM组外展角平均40．05°±2．54°，COC组39．30°±2．70°，无统计学差异（P=0．654）；MOM组前倾角平均15．60°±2．68°，COC组15．25°±2．20°，亦无统计学差异（P=0．131）。[结论]大直径金属对金属（MOM）全髋置换术的近期疗效优于陶瓷对陶瓷（COC）全髋置换术，特别是在关节活动度和早期下床活动方面，良好的疗效与手术技巧密切相关，中远期疗效需进一步观察。

[ Objective ] To discuss the short - term results and operative experience of metal - on - metal （MOM） versus ceramic - on - ceramic （COC） hearing surfaces in total hip arthroplasty （THA） . [ Methods ] Between April 2009 and January 2010, We retrospectively reviewed 20 patients （20 hips） performed with the MOM THA. At an average of 13 months period （ range, 11 to 20 months ） postoperatively, all hips were available for follow - up. Their age was （51.7±3.8 ） years, and body mass index was （23.3 ±2. 1 ） kg/m^2 . For comparison , We retrospectively reviewed 19 patients （20 hips） performed with the COC THA at the same time. All patients obtained an average follow -up of 15 months （range, 11 to 20 months ） . Their age was （53.1 -＋ 2. 9 ） years, and body mass index was （23.8±2. 6） kg/m^2. The Harris hip Score was used for clinical evaluation. The roentgenographic results were observed. [ Results ] No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred in either group. Clinical results ： there were no difference between the 2 groups about preoperative Harris score （ P 〉 0. 05 ）, the differences between the 2 groups were significant at 6 weeks , 3, 6 and 12 months （P 〈0. 05） . In the MOM group, 1 patient had weak thigh pain was found, no moder- ate or severe pain. In the COC group, no one had thigh pain. In the MOM group, the total range of hip motion was 228.35° ±9.72°. In the COC group, it was 191.15° ± 10. 59°. Obvious su- periority was observed in 2 groups （ P 〈 0. 05 ） . Radiographic re-suits： 39 （97.5%） femoral stems were in neutral position and 1 was in mild valgus. No implant had subsidence in the MOM group. In the COC group, 4 hips had less than 1.5mm subsidence, and there was no change in the latest follow up. In the MOM group, the abduction component abduction angle was 40. 05° ±2. 54, whereas the abduction angle for the COC group was 39. 30° ±2. 70° （P =0. 654） . the anteversion angle of the MOM group was 15.60° ±2.68°, whereas the average anteversion angle for the COC group was 15.25°± 2. 20° （P = 0. 131 ） . There was no significant difference between the two gYoups concerning the abduction angle and the anteversion angle （ P 〈 0. 05） . [ Conclusion] MOM THA may be better than COC THA, especially on the range of hip motion and early activity. Surgical skills was proved to be the most important factor contributing to the good resuhs. However, the medium and long- term results still need further follow-up.