第三代陶对陶人工全髋关节置换术治疗中青年髋关节疾病的中远期疗效

MID- AND LONG-TERM EFFECTIVENESS OF THIRD-GENERATION CERAMICON-CERAMIC TOTAL HIP ARTHROPLASTY IN YOUNGER PATIENTS

目的探讨采用第3代陶对陶（ceramic-on-ceramic,CoC）假体行人工全髋关节置换术（total hip arthroplasty,THA）治疗中青年髋关节疾病的中远期疗效。方法回顾分析2001年3月-2009年5月收治并符合选择标准的68例73髋采用第3代CoC假体行THA的中青年髋关节疾病患者临床资料。其中男39例,女29例;年龄18～50岁,平均38.6岁。股骨头缺血性坏死15例15髋,先天性髋关节发育不良9例9髋,强直性脊柱炎5例8髋,骨关节炎10例10髋,创伤性关节炎12例12髋,股骨颈骨折12例12髋,类风湿性关节炎4例6髋,股骨颈部肿瘤1例1髋。采用Harris评分及美国加州大学洛杉矶分校（UCLA）评分评估患者髋关节功能和活动水平,疼痛视觉模拟评分（VAS）评估术后大腿痛。影像学检查评估骨溶解、假体松动、陶瓷假体碎裂等相关并发症,并采用Kaplan-Meier生存分析评估假体生存情况。结果 68例患者均获随访,随访时间6～14年,平均9.7年。3例3髋采用＂三明治＂陶瓷内衬者出现内衬碎裂,行翻修术。1例1髋于术后3年重体力活动后出现髋关节异响,停止活动后异响消失。末次随访时患者Harris评分、UCLA评分均较术前显著改善（P〈0.05）。无大腿痛出现,VAS评分为0分。患者均获骨性固定,未出现骨溶解、假体松动及下沉等并发症。以陶瓷假体碎裂引起的翻修为终点,5年和10年累积生存率分别为98.6%及95.9%;以假体松动引起的翻修为终点,5年和10年累积生存率均为100%。结论第3代CoC假体可满足中青年患者THA的需要,中远期疗效满意。

Objective To analyze the mid- and long-term effectiveness of the 3rd-generation ceramic-on-ceramic（CoC） total hip arthroplasty（THA） in the younger patients. Methods A retrospective analysis was made on the clinical data of 68 younger patients（73 hips） who accepted the 3rd-generation CoC THA between March 2001 and May 2009. Of 68 cases, 39 was male and 29 was female with the average age of 38.6 years（range, 18-50 years）; there were 15 cases（15 hips） of osteonecrosis of the femoral head, 9 cases（9 hips） congenital dysplasia of the hip, 5 cases（8 hips） of ankylosing spondylitis, 10 cases（10 hips） of osteoarthritis of the hip joint, 12 cases（12 hips） of traumatic hip arthritis, 12 cases（12 hips） of femoral neck fracture, 4 cases（6 hips） of rheumatoid hip arthritis, and 1 case（1 hip） of tumor of the femoral neck. The Harris score and University of California Los Angeles（UCLA） score were used to evaluate the hip joint function and activity level respectively. The visual analogue scale（VAS） was used to assess postoperative thigh pain. Radiological signs of osteolysis, loosening, and alumina ceramic related complications were evaluated continuously. And the KaplanMeier survival analysis was used to assess the prosthesis survival. Results The average duration of follow-up was 9.7 years（range, 6-14 years）. Sandwich ceramic liners fracture was observed in 3 cases（3 hips）, and revision was performed; 1 case had ＂squeaking＂ hip because of physical activity. At last follow-up, Harris score and UCLA score were significantly improved when compared with preoperative scores（P〈0.05）. Bony healing was obtained in all patients, without osteolysis,loosening, and thigh pain. The VAS score was 0. The 5-year and 10-year cumulative survival rates for ceramic fracture revision were 98.6% and 95.9%, and the 5-year and 10-year cumulative survival rates for osteolysis and loosening revision both were 100%. Conclusion The 3rd-generation CoC prosthesis offer an excellent option for younger patients in THA and the mid- and long-term effectiveness are satisfactory.