髋臼缺损重建及骨水泥和非骨水泥全髋关节置换术临床观察

Follow-up Result of the Autofemoral Head in the Reconstruction Acetabulum with Cementless and Cemented Total Hip Replacement

目的 :寻找全髋置换术髋臼缺损处理的方法。并对骨水泥和非骨水泥全髋关节置换术临床观察比较。方法 :采用切下的股骨头 ,保留软骨修成帽状 ,软骨面位于腹腔侧 ,然后将假臼杯用骨水泥与重建的髓臼相嵌。同时将一组髋臼采用非骨水泥 ,而骨水泥固定股骨干假体 ,另一组采用骨水泥全髋关节置换。结果 :进行了临床和放射学随访。随访时间为 1～ 3 .5年 (平均为 2 .4年 )。发现非骨水泥组 16例优良率为 94% ,采用骨水泥置换组 16例优良率为 95 .6%。随访期间两者均未发现假体有松驰象。但非骨水泥组中有 2例行走时觉轻微疼痛。 98%随访者对手术效果满意。结论 :对 60岁以下用非骨水泥。 70岁以上用骨水泥为佳。对 60～ 70岁之间髋臼采用非骨水泥 ,而骨水泥固定股骨干假体效果更好。本文对选择人工关节类型、掌握骨水泥和非骨水泥适应证及术中出现髋臼缺损的处理有其重要指导意义。

Objective: There were 32 patients treated with autofemoral head in the reconstruction acetabulum with cementless and cemented hip prosthesis. A clinical and radiological follow up was performed 1 3.5 years after total hip replacement.4 cases were performed by autofemoral head in the reconstruction acetabulum.The average follow up period was 2.4 years (ranged from 12 to 42 months). Result: We found good or excellent results in 94% after cementless and 95.6% after cemented fixation. Two cases after cementless hip replacement suffered thigh pain in the early postoperative period. Complications were rare.No patient had required revision and radiological loosening. 98% of the patients were completely satisfied with these results. Conclusion. We prefer the cementless fixation in patients under 60 years old and cemented fixation in the group over 70 years old.Patients between 60 and 70 seems to benefit more from a fixation with an cementless acetabular component and a cemented shaft.