大直径陶瓷-陶瓷股骨头在保留股骨假体全髋关节翻修术中的应用

Use of large diameter ceramic-on-ceramic bearings in isolated revision of acetabular component

目的评价大直径陶瓷-陶瓷股骨头在保留股骨假体全髋关节翻修术中应用的临床疗效。方法回顾性分析自2006-01—2012-12在保留股骨假体全髋关节翻修术中应用直径36 mm陶瓷-陶瓷股骨头假体的32例（32髋）的临床资料。手术前后评估髋关节功能Harris评分,术后6周、6个月、1年及随后每隔半年随访中临床及X线片评价是否出现假体脱位、松动、下沉、骨溶解、陶瓷碎裂。结果 32例均获得随访平均26.2（11.0-38.0）个月。末次随访时髋关节功能Harris评分从术前平均68.9（9.0-87.0）分提高到85.0（39.0-98.0）分,差异有统计学意义（t=17.36,P=0.013）。均未出现假体脱位、松动、下沉、骨溶解、陶瓷破碎。结论大直径陶瓷-陶瓷股骨头在保留股骨假体的全髋关节翻修术中可以显著降低术后假体脱位率,不增加股骨侧假体周围骨溶解,可以获得较好的近、中期疗效。

Objective To evaluate the effect of large diameter ceramic-on-ceramic bearings in isolated revision of the acetabular component. Methods From January 2006 to December 2012, a total of 32 revision hip replacements were performed, in which acetabular component was revised to a new acetabular component with a ceramic liner and a large diameter head（36 mm）, while retaining the well-fixed femoral component. Harris score was examined before and after operation.Clinical and radiological assessment was undertaken at six weeks, six months, one year and then bi-annually thereafter. The latest follow-up radiographs were compared with the post-operative films for evidence of dislocation,subsidence, loosening,osteolysis and fracture. Results All patients received follow-up for 11.0-38.0 months, with an average of 26.2 months. The mean Harris hip score improved significantly from 68.9（9.0 to 87.0） pre-operatively to 85.0（39.0 to 98.0） at the last follow up（t =17.36, P =0.013）. There were no evidences of dislocation,subsidence, loosening, osteolysis and fracture. Conclusion The use of large diameter ceramic-on-ceramic bearings can significantly decrease the instability in isolated revision of the acetabular component. The lysis won＇t progress in patients. Good short-term effects can be achieved.