大直径金属-金属全髋关节置换的早期疗效

Short-term outcome of metal-on-metal total hip arthroplasty with large diameter head

背景:髋关节置换后脱位仍然是传统的金属对聚乙烯全髋关节置换的主要并发症之一,大直径金属对金属的全髋关节置换后具有良好的稳定性,适合年轻、活动要求高的患者。目的:验证大直径金属-金属全髋关节置换治疗终末期髋关节疾病的早期疗效。方法:回顾性分析48例(54髋)初次大直径金属-金属全髋关节置换后的早期临床疗效。假体股骨头直径平均为44mm(38～48mm),采用Harris评分和X射线检查评估早期疗效。结果与结论:所有患者都获得18～36个月随访,末次随访Harris评分平均93.6分(91～96分),疗效评价为优。末次随访时髋关节总活动度平均为232.6°(182～257°),置换后髋关节总活动度明显增大。所有患者切口均Ⅰ期临床愈合,无髋部和大腿疼痛、感染、关节脱位、血管、神经损伤等并发症,置换后X射线片示假体位置良好,无松动或下沉。提示大直径金属-金属全髋关节置换治疗终末期髋关节疾病具有早期低磨损、髋关节的活动度好、脱位率低等优点。

BACKGROUND：Dislocation after total hip replacement is still one of the main complications of traditional metal-on-polyethylene total hip replacement.Metal-on-metal total hip arthroplasty with large diameter head has a good stability,suitable for young and active patients with higher requirement of movement.OBJECTIVE：To evaluate the short-term therapeutic effect of total hip arthroplasty with metal-on-metal bearings and large diameter head hip prosthesis.METHODS：A retrospective analysis was done in 48 patients （54 hips） with advanced stage hip disease treated by primary total hip arthroplasty with metal-on-metal bearings and large diameter head hip prosthesis.The mean diameter of femoral head prosthesis was 44 mm （38 to 48 mm）.The postoperative short-term effect was evaluated with Harris scores and X-ray plain.RESULTS AND CONCLUSION：All patients received the follow-up of 18 to 36 months.The mean Harris hip score was 93.6 （91 to 96） at the last follow-up.The mean range of hip motion was 232.6° （182° to 257°） at the last follow-up.There were no infection,no hip and thigh pain,no vessel and nerve complications,no dislocation.Post-opretive X-ray plain revealed fine position of the prostheses without any loosening.Short-term results show that large diameter metal-on-metal total hip arthroplasty has advantages of lower wearing,large range of motion and few dislocations.