不同硬对硬摩擦界面全髋关节置换术后血清钴、铬浓度及临床疗效比较

Clinical Efficacy and Serum Cobalt,Chromium Metal Ion Concentrations after Total Hip Arthroplasty with Three Different Hard-on-Hard Bearings

目的比较全髋关节置换术(total hip arthroplasty,THA)中使用3种不同硬对硬界面后,2年内血清钴、铬金属离子浓度的变化,以及临床疗效有无差异。方法 90例THA患者分为陶瓷对陶瓷(COC)、陶瓷对金属(COM)、金属对金属(MOM)3组,每组30例。术前,术后3、6、12、24月检测血清钴、铬金属离子浓度,进行Harris评分,对患髋进行X片连续性观察和彩超检查。结果 3组术后24月患髋Harris评分达优率均为100%,连续X片显示髋臼假体周围未见透亮线、骨溶解等,彩超均未发现炎性假瘤。术后COM组和MOM组内金属离子浓度迅速升高,至12月时变化趋于平稳,并表现出下降趋势。但MOM组中铬离子浓度则继续上升,24月与12月时比较差异具有统计学意义(上升了0.48μg/L,P=0.021)。术后各时间点COC组相对恒定,MOM组钴、铬金属离子浓度大于COC组和COM组(P<0.05)。结论 3种硬对硬界面术后功能恢复好,无炎性假瘤、骨溶解的发生,都取得了满意的临床效果。COM血清钴、铬金属离子浓度低于MOM,高于COC。

Objective To compare the clinical efficacy and serum concentrations of cobalt, chromium metal ion in three different hard-on-hard bearings after total hip arthroplasty at 2-years postoperatively. Methods Ninety （90） THA patients were divided into ceramic-on-ceramic （COC）, ceramic-on-metal （COM）, metal-owmetal （MOM） group （n：30 in each group）. At preoperative and 3, 6, 12, 24 months postoperative 5 time points, serum concentrations of cobalt and chromium metal ion were measured, Harris hip score was evaluated, X-rays and color doppler ultrasound examination of the ipsilateral hip also were observed. Results The excellent rates of Harris hip score were 100% in three groups. Continuous X rays showed no radiolucent line around the acetabular component, no osteolysis, and no inflammatory pseudotumor. After the THA operation, the metal ion levels in COM and MOM groups increased rapidly, and stabilized at 12 months, then showed a downward trend, but the chromium ion level of MOM continued to rise at 24 months, with a significant difference when compared with that at 12 months （an increase of 0.48 /,g/L, P=0. 021）. The serum concentrations of metal ion in COC group were relatively constant at all time points, and the cobalt, chromium ion levels of MOM group were significantly higher than those of COC and COM group. Conclusion The postoperative functional recovery of the three hard owhard bearings all were good, and no inflammatory pseudotumor and osteolysis were found. The serum levels of cobalt, chromium ion of COM were lower than those of MOM, but higher than those of COC.