大直径股骨头假体在人工髋关节翻修术中的应用

The role of large femoral head components in revision of total hip arthroplasty

目的探讨人工髋关节翻修术中使用大直径股骨头假体对预防术后关节不稳定的有效性。方法回顾性分析2005年8月至2010年12月进行人工髋关节翻修术使用28mm股骨头假体的107例（112髋）及使用36mm股骨头假体的46例（46髋）的患者资料。所有手术均由同一组医生完成。其中使用28mm股骨头假体（28mm组）的患者中男性8l例（85髋），女性26例（27髋），年龄26-79岁，平均（62±17）岁；使用36mm股骨头假体（36mm组）的患者中男性33例（33髋），女性13例（13髋），年龄31-77岁，平均（60±16）岁。统计对比最后随访时两组的脱位率和Harris评分。结果28mm组平均随访43．3个月，共出现7髋脱位，脱位率为6．2％；其中使用加强环翻修者脱位2例，脱位率为9．5％，使用打压植骨技术翻修者脱位3例，脱位率为8．3％，使用生物臼翻修者脱位2例，脱位率为3．6％。36mm组平均随访26．7个月，仅出现1例脱位，脱位率为2．2％，且此例为臀中肌损伤患者，排除这例，脱位率为0。两组脱位率相比，差异有统计学意义（X^2=103．0095，P〈0．01）。28mm组患者末次随访时Harris评分为（88±11）分，36mm组患者末次随访时Harris评分为（89±9）分，两组比较差异无统计学意义（P〉0．05）。结论大直径股骨球头假体可显著降低人工髋关节翻修术后关节的脱位率，应该在人工髋关节翻修术中提倡使用大直径股骨球头假体。

Objective To study the efficiency of decreasing instability of large femoral head components in revision total hip arthroplasty （THA）. Methods From August 2005 to December 2010, 107 patients （112 hips） with 28 mm femoral head components（28 mm group） and 46 patients （46 hips） with 36 mm femoral head components（ 36 mm group） in revision THA were analyzed retrospectively in order to find if the dislocation rate and Harris hip score were different between the two groups at the time of last follow-up. All the operations were performed by the first author. There were 81 male patients （85 hips） and 26 femal patients （27 hips） in 28 mm group with mean age of （62 ± 17） years（26-79 years） and 33 male patients （33 hips） and 13 female patients （13 hips） in 36 mm group with mean age of （60 ± 16） years （31-77 years）. Results The mean follow-up period was 43.3 months（33-71 months） for28 mm group and 26. 7 months（ 12-37 months） for 36 mm group. There were 7 patients dislocated after revision in 28 mm group, including 2 revised with reinforcement rings （with dislocation rate 9. 5% ） , 3 revised with impaetion bone grafting technique （with dislocation rate 8.3% ） and 2 revised with cememtless cups （with a dislocation rate 3.6% ）. The dislocation rate of this group was 6. 2%. While the dislocation rate of 36 mm group was 2. 2%, the only dislocated patient was because of loss of gluteus medius muscle function in the index operation. If this case was excluded, the dislocation rate of 36 mm group would be 0. There was significant difference between the two groups（ X^2 = 103. 0095 ,P 〈 0. 01 ）. The Harris hip score was 88 ± 11 for 28 mm group and 89 ± 9 for 36 mm group, there was no significant difference between the two groups （ P 〉 0. 05）. Conclusion The large femoral head components can significantly decrease the instability after revision THA, which should be used in revision THA.