金属对金属全髋关节表面置换术的近期疗效

Preliminary results after metal-on-metal hip resurfacing arthroplasty

目的分析金属对金属全髋关节表面置换术的近期疗效，探讨其适应证选择和技术要点。方法2006年1月至2010年10月因股骨头坏死、髋关节骨关节炎、髋关节发育不良、强直性脊柱炎接受全髋关节表面置换术104例（116髋），其中男59例（66髋），女45例（50髋）；年龄16-67岁，平均39．7岁。均采用Conserve Plus假体，依据比利时技术标准完成全髋关节表面置换术。术后1个月、3个月、6个月、1年及之后每年随访一次，摄X线片并统计Harris髋关节评分。结果101例（112髋）获得随访，随访率97．1％。随访时间9-66个月，平均33个月。Harris髋关节评分由术前平均（37．6±6．3）分提高至末次随访时（91．3±5．3）分，其中优104髋、良7髋、差1髋，优良率99．1％（111／112）。末次随访时，髋臼假体外展角36。±55°，平均42．7°；股骨假体柄干角132°±146°，平均138．5°。随访期间出现异位骨化2例（2．0％，2／101），分别为BrookerⅢ型1例及BrookerⅡ型1例，均无症状，未予处理。术后并发假体脱位1例（1．0％，1／101），经手法复位及卧床1个月治愈，未再发生脱位。无股骨颈骨折、假体松动、感染及翻修病例。结论严格选择手术适应证，配合精确的手术技术，金属对金属髋关节表面置换术可获得良好的近期疗效。

Objective To introduce the technique of metal-on-metal hip resurfacing arthroplasty, evaluate its preliminary clinical results and review the factors which affect the results. Methods From January 2006 to October 2010, 104 patients （116 hips） with osteonecrosis of the femoral head, hip osteoarthritis, hip dyplasia, or ankylosing spondylitis were treated with the total hip resurfaeing arthroplasty. Among them, 59 patients （66 hips） were male, and 45 patients （50 hips） were female, with an average age of 39.7 years （range, 16-67 years）. Standard operation technique was performed for all patients with Conserve Plus prosthesis. Each patient was followed up at 1 month, 3 months, 6 months, 1 year postoperatively. Results Three patients （4 hips） were lost, so 101 patients （112 hips） were followed up for an average period of 33 months （range, 9-66 months）. The average Harris hip score was improved significantly from 37.6±6.3 preoperatively to 91.3±5.3 at final follow-up; 104 hips were excellent, 7 hips were good, 1 hip was poor, and the excellent and good rate was 99.1%. At final follow-up, the average abduction angle of the acetabular cup was 42.7° （range, 36°-55°）; the average femoral prothesis stem-shaft angle was 138.5° （range, 132°-146°）. Two patients presented with heterotopic ossification （Brook Ⅲ and Brook Ⅱ）. One patient presented with prothesis dislocation, which healed after being treated with manual reduction. There was no femoral neck fracture, infection, or prosthesis loosening. Conclusion With strict patient selection criteria and optimized technique, the short-term results of metal-on-metal hip resurfacing arthroplasty are satisfactory.