氧化铝全陶瓷内衬对陶瓷头界面全髋置换的临床疗效分析

Intermediate outcomes of alumina-on-alumina bearing total hip arthroplasty

目的分析第三代氧化铝全陶瓷内衬对陶瓷头界面在初次全髋关节置换术的中期临床疗效。方法回顾性收集1999年1月至2005年10月135例患者临床资料，共获得有效随访患者119例，共146例髋。其中髋臼侧均为羟基磷灰石（HA）涂层压配固定臼杯，股骨侧123例为非骨水泥HA近端涂层压配固定，23例为锥形光面骨水泥固定，所有假体的头臼界面均为氧化铝陶瓷头对全陶瓷内衬。进行最短时间5年以上，平均（72．9±10．9）个月的随访，对其进行临床和影像学检查评估疗效。结果髋关节功能Harris评分从术前平均（49．6±7．9）分提高到术后末次随访（91．7±3．0）分（P〈0．05）。以翻修作为终点的假体5年生存率为96．6％。1例因髋臼杯移位松动而翻修；1例出现外伤性股骨假体周围骨折，行翻修术；1例患者因轻微外伤后并发陶瓷内衬破损行翻修术；另2例因感染而翻修。此外，16例术中并发股骨侧截骨面皮质劈裂，延迟负重后无假体松动下沉；1例髋术中并发髋臼骨折，行保守治疗后髋臼无松动；2例术后出现脱位，保守治疗成功；2例出现非典型性关节异响，非手术治疗后消失。其余无论是骨水泥或非骨水泥假体，假体髋臼侧和股骨侧均固定稳定，假体周围无骨溶解，假体无明显松动和下沉。结论第三代氧化铝全陶瓷内衬对陶瓷头界面假体用于初次全髋置换中期临床随访结果满意，但需要避免陶瓷界面特有的并发症，假体使用需要注意良好的临床技术。

Objective To explore the intermediate outcomes of third-generation alumina-on-alumina total hip arthroplasty （THA）. Methods A consecutive series of 165 primary alumina-on-alumina total hip arthroplasties were performed in 135 patients. Three patients died and 13 patients lost follow-up so that a total of 119 patients （ 146 hips ） were available for study. The mean patient age was 53.4± 11.0 years old （range： 26 -79）. Hydroxyapatite. （HA）-coated press-fit acetabular cups were used in all cases. At femoral side, 123 cases were implanted with HA-coated uncemented stems and 23 cases implanted with high polished double taped cemented stems. All patients were evaluated clinically and radiographically after a minimal follow-up duration of 60 months. Results The preoperative mean Harris hip score of 49. 6 ±7.9 points improved to 91.7±3.0 points at the last follow-up （P 〈0. 05）. The 5-year survival for any reason lead to revision was 96. 6%. Five hips were under revision, 1 for acetabular shell loosening and migration, 1 for Vancouver B2 periprosthetic fracture, 1 for fracture of pure alumina liner and 2 for infections. All other prostheses demonstrated no radiographic evidence of loosening. No periprosthetic osteolysis was found. There were 2 cases of dislocations and 2 patients presented postoperatively with ＂squeaking-like＂ hips. Conclusion The clinical and radiographic outcomes after primary THA with third-generation ceramic-on-ceramic bearing surfaces are favorable after a minimal follow-up duration of 5 years. The modified alumina-on-alumina bearing implants offer a better option for younger and active patients.