羟基磷灰石涂层股骨柄假体髓腔充填情况对临床效果的影响

Influence of Filling Situation of Intramedullary Canal on Clinical Effect of Total Hip Arthroplasty by Using Hydroxyapatite-coated Femoral Stem Prosthesis

目的探讨在初次人工全髋关节置换术中羟基磷灰石全涂层股骨柄髓腔充填情况对假体稳定性及其髋关节功能预后的影响。方法回顾性分析2007年4月—2010年11月使用Corail全羟基磷灰石涂层股骨柄进行初次人工全髋关节置换术的121例(144髋)临床资料,根据年龄分为A组(年龄<55岁)78例、B组(年龄≥55岁)43例。采用Harris和SF-36评分方法评价术后功能的恢复情况,测量术前、术后及随访X线片中股骨及假体髓腔充填率及假体位置的变化。结果所有病例均恢复行走功能,平均随访时间46月,术后2年Harris评分、SF-36评分较术前均有显著性提高(P<0.05),两组间评分差异无显著性(P>0.05);术后第2天及24个月双髋关节正、侧位X线片显示B组髓腔充填率显著高于A组(P<0.01),两组术后24个月与术后第2天比较,髓腔充填率差异均无统计学意义(P>0.05)。最终影像评估所有股骨假体位置无明显移位、松动或下沉,无关节翻修病例。结论尽管Corail全羟基磷灰石涂层股骨柄假体的股骨髓腔充填率较低,使用该假体的关节置换仍取得较好的临床疗效和影像学稳定性。

Objective To explore the influence of filling situation of Corail entire Hydroxyapatite （HA）-eoated femoral stem prosthesis in primary total hip arthroplasty （THA） on prosthetic stability and prognosis of thurl function. Methods Clinical data of 121 patients （144 hips） who underwent primary THA by using Corail stem prosthesis during April 2007 and November 2010 was retrospectively analyzed. The patients were divided into group A （n = 43 ） who were not more than 55 years old, and group B （n = 78） who were equal or more than 55 years old. The postoperative functional rehabilitation was evaluated with Harris and SF-36 scores, and filling ratios of femur and intramedullary canal of prosthesis, and changes of prosthesis position were detected before and after operation, and in follow-up by radiograph. Resuits All the patients recovered walking function. The average time of follow-up was 46 months. The scores of Harris and SF-36 at 2 years after operation were significantly higher than those before operation （P 〈 0.05） , but there were no statistical differences between the two groups （P 〉 0.05） ; the filling ratios of femoral intramedullary canal at normotopia and lateral position in both hip joints 2 d and 24 months after operation in group B were significantly higher than those in group A（P 〈 0. 01 ） , but the difference in filling ratio of femoral intramedullary canal between 24 months and 2 d after operation in the two groups was not statistically significant（P 〉 0.05）. There was no significant displacement, loosening, subsidence or joints overhauling by iconography evaluation. Conclusion The filling ratio of Corail prosthesis is lower, but the method may get better curative effect and eikonic stability.