双极人工股骨头与全髋关节置换术在老年患者股骨头缺血性坏死FicatⅢ期的中远期随访比较

Mid-long term results of Bipolar prosthetic replacement versus total hip arthroplasty for Ficat stage Ⅲosteonecrosis of the femoral head in senile patients

目的比较生物型双极人工股骨头置换与全髋置换术治疗老年FicatⅢ期股骨头缺血性坏死患者的中远期疗效。方法对获得随访的61例(64髋)FicatⅢ期股骨头缺血性坏死患者,其中23例(24髋)行生物型双极人工股骨头置换、38例(40髋)行全髋关节置换术对其行回顾分析比较,观察手术前后Harris评分和术后髋部疼痛、影像学变化等情况。结果术后随访5～13年(平均8年),末次随访Harris评分全髋置换组(88.5±8.9)分,较股骨头置换组(73.5±8.3)分高,差异有统计学意义(t=6.69,P<0.05)。在疼痛发生率及翻修率上股骨头置换组分别为37.5%(9/24)、29.2%(7/24),均较全髋置换组10%(4/40)、7.5%(2/40)高,差异有统计学意义(2=5.41、2=5.39,P均<0.05)。随访X线检查假体位置,股骨头置换组9例出现髋臼磨损,发生率为37.5%;全髋置换组髋臼松动率为2.5%(1/40),假体柄松动率为5%(2/40);股骨头置换组5例出现股骨柄松动,发生率为20.8%(5/24),两组在股骨柄松动发生率上差异无统计学意义(2=2.41,P>0.05);在股骨侧骨溶解发生率上股骨头置换组20.8%(5/24)与全髋关节置换组22.5%(9/40)间的差异无统计学意义(2=2.44,P>0.05)。结论治疗老年FicatⅢ期股骨头缺血性坏死选择双极股骨头置换术应慎重,对于大多数患者,应积极选用生物型全髋置换术。

Objective To compare the mid-long term result of cementless bipolar hemiarthroplasty and total hip arthroplasty for Ficat stage Ⅲ osteonecrosis of the femoral head in old age patients.Methods 61 patients（64 hips） with Ficat stage Ⅲ osteonecrosis of the femoral head were followed up.23 patients（24 hips） and 38 patients（40 hips） were treated with cementless bipolar hemiarthroplasty and total hip arthroplasty respectively.The pre-and postoperative Harris hip score,postoperative hip pain,and radiographic changes were observed.Results Patients were followed up 5-13 years（average eight years）.In the last follow-up,the Harris hip score of total hip arthroplasty group was（88.5±8.9） which was higer than that of hemiarthroplasty group（73.5±8.3）（t=6.69,P0.05）.As for the incidence of postoperative pain and revision rate,hemiarthroplasty group was 37.5%（9/24）,and 29.2%（7/24） respectively which was higher than that of total hip arthroplasty group which was 10%（4/40） and 7.5%（2/40） respectively;the differences were statistically significant（x2=5.41,x2=5.39,both P0.05）.The prostheses were examined by X-ray during follow-up.There were nine cases of acetabular wear in hemiarthroplasty group,and the incidence rate was 37.5%;while the rate of stem loosening was 5%（2/40）.Acetabular and stem loosening in total hip arthroplasty group were 2.5%（1/40）,5%（2/40） respectively.There was no significant difference in stem loosening of the two groups（x2=2.41,P0.05）.The incidence of the femoral osteolysis in hemiarthroplasty group was 20.8%（5/24） and was 22.5%（9/40） in total hip arthroplasty group.There was no significant difference（x2=2.44,P0.05）.Conclusions It should be cautious when using bipolar hemiarthroplasty to treat Ficat stage Ⅲ osteonecrosis of the femoral head for old age patients.For most patients,cementless total hip arthroplasty should be more preferred.