金属对金属大直径股骨头全髋关节置换术的临床应用及近期疗效观察

Clinical application and therapeutic effectiveness of large diameter head metal-on-metal total hip replacement

目的总结金属对金属大直径股骨头全髋关节置换术（totalhipreplacement，THR）的近期疗效。方法回顾性分析行金属对金属大直径股骨头THR患者34例34髋。临床评估以Harris评分及髋关节活动度为标准。影像学根据双髋关节正位片，观察髋臼、股骨假体的位置及周围骨质的改变。结果34例患者平均随访18．7个月。术后均无假体周围透亮线产生，无骨溶解、假体松动、异位骨化及假体断裂等并发症。Harris评分由术前的20～48分，平均（35．29±8．59）分，提高至术后随访时的76～96分，平均（87．82±5．12）分。所有患者髋关节活动度术后显著提高。结论采用金属对金属大直径股骨头THR治疗髋关节骨性关节炎、股骨头无菌性坏死、股骨颈骨折及先天性髋臼发育不良患者的近期疗效良好，但中长期临床结果仍需进一步研究。

Objective To explore the short-term results of total hip replacement （THR）using large diameter heads（LDH） in metal-on-metal （MOM）articulation. Methods A consecutive series of 34 patients（ 34 hips）who underwent THR using LDH in MOM articulation were studied. The results were e- valuated both clinically and radio graphically. Clinical outcomes were evaluated according to the Harris e- valuation score and the ROM （ Range of motion ）. Acetabular position, components migration and bone changes around the implant were measured radiographically. Results The average follow-up period of all 34 patients was 18.7 months. There was no bright line around the prosthesis. No complications such as os- teolysis, prosthetic loosening, heterotopic ossification and prosthesis fracture occurred. The average Harris hip score at the last follow-up was significantly improved compared with the preoperative scores （87.82 points versus 35.29 points）. The postoperative ROM of all patients improved remarkably. Conclusion The short-term results of LDH in MOM total hip replacement on hip osteoarthritis, aseptic femoral head necrosis, femur neck fracture and congenital hip hypoplasia are excellent. But the long-term results of THR using LDH in MOM articulation still need further investigation.