初次全髋关节置换术后5年以上随访结果与分析

Primary total hip arthroplasty: a minimum five-year follow-up study

目的评估初次全髋关节置换术（THA）后5年以上患者的临床疗效、并发症及其影响因素。方法对中山大学附属第一医院关节外科2006年6月前行THA的273例患者（305髋）进行随访,截至末次随访时,191例（206髋）患者获得随访,随访时间平均为9.3年（5-21年）,临床随访内容包括SF-36量表、术前、术后Harris评分及各种并发症。影像学评估包括骨盆正位、患髋正侧位片,判断人工假体位置、假体周围骨质以及并发症情况。结果随访率为69.96%,SF3-6体能方面总分由术前的（30.92±3.90）分（24~39分）提高至（53.69±3.97）分（44~62分）,在精神方面的总分则由术前的（45.91±5.63）分（37~56分）提高至（57.06±7.26）分（43~72分）。术前Harris评分为（46.71±10.76）分（5~68分）,末次随访时为（92.83±4.88）分（56~100分）。假体的5年生存率为98.06%,10年生存率为94.17%,15年生存率为85.92%,20年生存率为81.55%。混合型假体、非骨水泥型假体的翻修率分别为2.4%、5.6%。术后并发症包括跛行（17例）、脱位（3例3髋）、深静脉血栓（1例1髋）、假体周围骨折（1例1髋）、无菌性松动（9例9髋）、异位骨化（6髋）和感染（0例）等。结论本组病例整体疗效满意、假体生存期长,但随访率偏低,病例数偏少,需进一步完善随访机制,提高随访率。

Objective To evaluate clinical efficacy,complications and impact factors of the primary total hip arthroplasty（THA） for more than five years.Methods From Jan 1990 to Jun 2006,primary THA was performed on 305 hips（273 patients）,and 206 hips（191 patients） with complete clinical data were available for follow-up at a mean time of 9.3 years（5 to 21 years） postoperatively.Clinical follow-up included SF-36 scores,preoperative and postoperative Harris hip score and complications.Components migration,bone remodeling around the implant and complications were also assessed in the anterior posterior and lateral X-ray of the hips.Results The follow-up rate was 69.96%.The average SF-36 scores on PCS（physical component summary,） was（30.92±3.90） points（ranging from 24 to 39 points） preoperatively and（53.69±3.97） points（44 to 62 points） at the final follow-up.The arerage MCS（mental component summary） was（45.91±5.63） points（range 37 to 56 points） preoperative and（57.06±7.26） points（range 43 to 72 points） at the final follow-up.Average Harris Hip Score was（46.71±10.76） points preoperatively and（92.83±4.88） points at the final follow-up.Using the endpoint defined as revision surgery and radiographic loosening,the survivorship rate was 98.06% for five years,94.17% for 10 years,85.92% for 15 years,and 81.55% for 20 years.Hybrid prosthesis and cementless prosthesis survivorship rates were 97.6.4% and 94.4% respectively.Complications included limp（17 cases）,prosthesis dislocation（three hips）,deep vein thrombosis（one hip）,periprosthetic fracture（one hips）,aseptic loosening（nine hips）,ectopic ossification（six hips）.There was no infection observed.Conclusions Patients in this study had satisfactory clinical and radiographic outcomes at a minimum follow-up of five years.The low follow-up rate and insufficient cases suggest necessity of further follow-up study.