第三代陶瓷关节假体人工全髋关节置换术中长期疗效观察

MEDIUM-AND LONG-TERM EFFECTIVENESS OF THIRD-GENERATION CERAMIC-ON-CERAMIC TOTAL HIP ARTHROPLASTY FOR END-STAGE HIP DISEASE

目的总结采用第3代陶瓷关节假体行人工全髋关节置换术（totalhiparthroplasty，THA）治疗髋关节终末期疾病的中长期疗效。方法回顾分析2001年5月-2005年5月采用第3代陶瓷关节假体行THA的142例（148髋）患者临床资料。男78例，女64例；年龄23～81岁，中位年龄57．2岁。股骨头缺血性坏死73例（77髋），退行性骨关节炎35例（36髋），股骨颈骨折18例（18髋），类风湿性关节炎14例（15髋），化脓性髋关节后遗症2例（2髋）。患者术前髋关节功能Harris评分为（58．3±12．9）分。结果术后患者切口均Ⅰ期愈合，无早期并发症发生。患者均获随访，随访时间为7～12年，平均8．8年。末次随访时，髋关节Harris评分为（92．5±10．2）分，较术前显著提高（t=-25．29，P=0．00）；4髋出现腹股沟部疼痛，6髋发生大腿疼痛。术后发生髋臼假体无菌性松动2髋，髋关节脱位2髋，陶瓷股骨头碎裂1髋，陶瓷异响1髋。假体翻修率为1．35％（3／148）。X线片复查示，2髋出现髋臼假体松动，4髋发现不连续透亮线，88髋可见骨长入；25髋股骨柄假体周围见不连续透亮线，95髋可见骨长入，2髋出现皮质骨肥大，9髋发生股骨柄假体下沉，但下沉均未超过2mm。结论采用第3代陶瓷关节假体行THA是治疗髋关节终末期疾病的有效方法，可获得满意的中长期疗效以及较高的假体存留率。

Objective To evaluate the medium- and long-term effectiveness of the 3rd-generation ceramic-on- ceramic total hip arthroplasty （THA） for end-stage hip disease. Methods A retrospective analysis was made on the clinical data of 142 patients （148 hips） who underwent the 3rd-generation ceramic-on-ceramic THA between May 2001 and May 2005. There were 78 males and 64 females, aged 57.2 years on average （range, 23-81 years）. Preoperative diagnosis was avascular necrosis of femoral head in 73 patients （77 hips）, degenerative osteoarthritis in 35 patients （36 hips）, femoral neck fracture in 18 patients （18 hips）, rheumatoid arthritis in 14 patients （15 hips）, and septic hip sequelae in 2 patients （2 hips）. The preoperative Harris hip score was 58.3 ± 12.9. Results All incisions healed by first intention without complication. All patients were followed up 8.8 years on average （range, 7-12 years）. At the last follow-up, the Harris hip score （92.5 ± 10.2） was significantly higher than that at pre-operation （t= 25.29, P=0.00）. At the last follow-up, there were 4 hips with groin pain, 6 hips with thigh pain. Complications occurred in 6 cases （6 hips）, including loosening cups in 2 hips, hip dislocation in 2 hips, ceramic head fracture in 1 hip, and squeaking in 1 hip. The revision rate was 1.35% （3/148）. X-ray film showed that acetabular cup loosening in 2 hips, discontinuous radiolucent line in 4 hips, and new bone formation in 88 hips; discontinuous radiolucent line around femoral component was observed in 25 hips, endosteal new bone formation in 95 hips, cortical bone hypertrophy in 2 hips, and femoral component subsidence in 9 hips （less than 2 mm）. an effective treatment for end-stage hip disease, and can achieve implant survival rate. Conclusion Third-generation ceramic-on-ceramic THA is satisfactory medium- and long-term effectiveness and a high