骨水泥型假体和生物型假体中年全髋关节置换:5年随访比较

Bone cement versus uncemented total hip arthroplasty in the middle-aged patients:5-year follow-up

背景:目前对于老年全髋关节置换的研究开展较多,无论是围手术期治疗还是置换后功能恢复等均日趋完善,但针对中年全髋关节置换的研究较少,尤其是置换后长期随访以及远期疗效尚存在诸多急待解决的问题。国内有关中年患者在全髋关节置换时如何选择假体,该选用何种类型何种材料的假体研究较少,临床中可参考的依据不多。目的:对比分析骨水泥型全髋置换和生物型全髋置换对中年患者的修复效果。方法:对2005年1月至2008年1月在新疆维吾尔自治区中医医院骨科接受全髋置换的60例中年患者进行5年的随访分析,年龄(37±6)岁,其中接受生物型全髋置换的患者32例,接受骨水泥型全髋置换的患者28例。统计置换后6个月、2年及5年的肢体功能恢复Harris评分及影像学评估结果,并进行对比分析。结果与结论:生物组患者的肢体功能恢复Harris评分在置换后6个月、2年、5年3个时点上均明显优于骨水泥组(P<0.01)。生物组置入6个月后无并发症,2年后有1例发生自发溶骨性疾病,5年后2例发生假体松动。骨水泥组置入后6个月2例发生自发溶骨性疾病,1例出现假体松动,2年后3例在出现假体松动,5年后2例出现线性渗透溶。提示对于中年患者,生物型假体在髋关节功能恢复和减少并发症方面较骨水泥型假体更有优势。至少在5年的随访过程中获得了更令人满意的临床和影像学结果。

BACKGROUND：Currently,the study of total hip arthroplasty in elderly is more.Perioperative treatment and postoperative rehabilitation are increasingly perfect,but the study of middle-aged total hip arthroplasty is less,especially long curative effect in postoperative and long-term follow-up still has many problems to be solved.In China,there are few studies addressing how to select the prosthesis during total hip arthroplasty in middle-aged patients,which kind or material of prosthesis is better,so the evidence for clinical application is less.OBJECTIVE：To compare and analyze the repair effects of bone cement total hip arthroplasty and uncemented total hip arthroplasty in middle-aged patients.METHODS：A total of 60 middle-aged patients who received total hip arthroplasty in the Department of Orthopedics,Xinjiang Uygur Autonomous Region Chinese Medicine Hospital from January 2005 to January 2008were followed up for 5 years.Their mean age was（37±6） years.There were 32 cases undergoing uncemented total hip arthroplasty and 28 cases receiving bone cement total hip arthroplasty.At 6 months,2 and 5 years after replacement,Harris score for recovery of limb function and imaging findings were compared and analyzed.RESULTS AND CONCLUSION：Harris score for recovery of limb function was significantly better in the uncemented total hip arthroplasty group than in the bone cement total hip arthroplasty group at 6 months,2 and 5 years after replacement（P〈0.01）.No complications were found at 6 months in the uncemented total hip arthroplasty group,but one case affected osteolysis at 2 years and two cases experienced prosthesis loosing at 5 years after arthroplasty.In the bone cement total hip arthroplasty group,two cases had osteolysis and one case had prosthesis loosing at 6 months after arthroplasty,three cases had prosthesis loosing at 2 years,and two cases affected linear permeability dissolvement at 5 years after arthroplasty.These findings suggest that uncemented prosthesis achieved a high rate of functional restoration and a low rate of complications in middle-aged patients.Uncemented total hip arthroplasty had satisfactory clinical and radiographic outcomes at a minimum of 5-year follow-up.