采用锥形股骨近端组配柄假体行全髋关节置换术的早期疗效

Preliminary results of a tapered proximal femur modular stem in total hip arthroplasty

目的探讨应用锥形股骨近端组配柄假体行全髋关节置换术（total hip arthroplasty，THA）的早期疗效与并发症。方法2010年10月-2011年12月采用锥形股骨近端组配柄假体行THA 50例（56髋），其中男14例，女36例；平均年龄61岁（25～82岁）。单髋44例，双髋6例。发育性髋关节发育不良伴继发性骨性关节炎15例，股骨颈骨折12例，股骨头缺血性坏死10例，原发性髋关节骨性关节炎9例，类风湿性髋关节炎2例，股骨颈骨折畸形愈合1例，股骨头骨折伴髋关节后脱位1例。股骨侧假体均采用锥形股骨近端组配柄假体行生物学固定。关节头臼界面采用金属一聚乙烯组合34髋，陶瓷-聚乙烯组合12髋，陶瓷-陶瓷组合lO髋。关节头采用标准球头（28mm）48髋，非标准头（〉28ram）8髋。结果48例（54髋）患者获随访平均11个月（6～19个月）。术前Harris髋关节评分平均36分（4～71分），末次随访时平均89分（55～98分）。末次随访时大腿轻度疼痛1例，中度疼痛1例，无重度、极重度疼痛。末次随访时无假体移位或松动现象；股骨侧可见假体周围骨性固定53髋，纤维性稳定1髋，假体下沉〈2mm者1髋，其余均无假体下沉。术中髋臼穿透1髋，假体周围骨折1髋。结论锥形股骨近端组配柄假体行THA早期疗效满意，但组配柄结合处存在磨损或侵蚀，甚至发生断裂的潜在风险。

Objective To investigate the preliminary results and complications of a tapered proximal fenmr modular stem in total hip arthroplasty （THA）. Methods From October 2010 to December 2011 , tapered proximal femur modular stems were used for THA in 50 patients （56 hips）. There were 14 males and 36 females, at a mean age of 61 years （range, 25-82 years）. Forty-four patients had unilateral THA and six bilateral THA. Hip osteoarthritis secondary to developmental dysplasia of the hip occurred in 15 patients, femoral neck fractures in 12, avascular necrosis of the femoral head in 10, primary hip osteo- arthritis in nine, rheumatoid hip arthritis in two, malunion of femoral neck fracture in one, and femoral head fracture combined with posterior dislocation of the hip in one. The adopted femoral component was a tapered proximal femur modular stem. Femoral head-acetabulum interface composed metal-polyethylene in 34 hips, ceramics-polyethylene in 12 hips, and ceramics-ceramics in 10 hips. There were 48 hips with standard femoral head （28 mm） and eight hips with non-standard femoral head （ 〉28 mm）. Results Mean period of follow-up was 11 months （range, 6-19 months） and two patients （two hips） were lost to follow-up. Harris hip score improved from 36 points （range, 4-71 points） preoperatively to 89 points （range, 55-98 points） at the final follow-up. There was one patient with mild pain in the thigh, one moderate pain, but none severe or critically severe pain at the final follow-up. At the final follow-up, no migration or loosening of the implanted prostheses occurred; periprosthetic bone ingrowth fixation on the femoral side was achieved in 53 hips and fibrous stable fixation in one hip; apart from one hip of 〈 2 mm prosthetic subsidence, the remained revealed no subsidence of the prostheses. Intraoperative complications included acetabulum perforation in one hip and periprosthetic femoral fracture in one hip. Coneluslon The short-term results are satisfactory, but the potential risk of fretting/corrosion and even breakage at the modular stem junction remains.