陶瓷对陶瓷短柄全髋关节置换术治疗中青年股骨头坏死的临床疗效

目的探讨陶瓷对陶瓷短柄全髋关节置换术治疗中青年股骨头坏死的早期疗效，为临床选择治疗方案提供参考。方法选择股骨头坏死患者44例（46髋），年龄28—52（39．94±5．25）岁；将患者按使用假体类型分为两组：对照组（22例24髋）使用Duraloc金属对聚乙烯假体，观察组（22例22髋）使用陶瓷对陶瓷Metha短柄假体。对比两组患者Harris评分、WOMAC评分和随访情况等。结果观察组和对照组术后WOMAC评分、Harris总分和功能、活动范围、疼痛、畸形子评分均较术前明显改善[观察组：（27．46±4．19）分比（66．38±5．84）分、（92．73±7．68）分比（42．67±7．28）分、（45．28±5．34）分比（22．19±4．19）分、（4．46±0．63）分比（3．25±0．66）分、（39．54±1．54）分比（15．39±2．86）分、（3．45±0．65）分比（1．84±0．32）分；对照组：（28．16±4．07）分比（65．67±6．22）分、（93．03±7．54）分比（43．74±7．57）分、（44．65±5．26）分比（22．45±4．37）分、（4．74±0．71）分比（3．17±0．59）分、（39．87±1．26）分比（16．19±2．55）分、（3．77±0．73）分比（1．93±0．43）分]，差异有统计学意义（P〈0．05）；两组间比较差异均无统计学意义（P〉0．05）。所有患者术后随访12—36（23．19±3．66）个月，观察组出现1例下肢肿胀，对症治疗后痊愈；对照组出现1例患肢肿胀，1例皮下广泛出血，对症治疗后均痊愈，出现1例股骨脱位，实施手法复位后未见二次脱位。结论陶瓷对陶瓷短柄全髋关节置换术治疗中青年股骨头坏死与金属对聚乙烯假体在改善患者髋关节功能及临床症状上效果相当，但短柄陶瓷对陶瓷假体耐磨性更好，摩擦系数小，适用于中青年患者。

Objective To investigate short term effect of brachypodium total hip arthroplasty for young patients with osteonecrosis, and to provide a reference for clinical treatment. Methods From January 2008 to January 2012, 44 cases of femoral head necrosis patients (46 hips) were selected, with age from 28 to 52, and average age (39.94 ± 5.25) years old; according to prosthesis type they were divided into control group and observation group, control group( 22 cases of 24 hips, using metal-on-polyethylene Duraloc total hip prosthesis replacement treatment), and in the observation group (22 cases of 22 hips, with use of ceramic-on-ceramic Metha Brachypodium total hip prosthesis replacement therapy). Patients were followed up for 12 to 36 months, Harris score, range of motion and other indicators were compared in two groups of patients. Results In observation group and control group, the level of WOMAC score, total Harris score and function, motion range, pain, abnormalities score were significantly improved compared with those before operation:in observation group:(27.46 ± 4.19) scores vs.(66.38 ± 5.84) scores, (92.73 ± 7.68) scores vs.(42.67 ± 7.28) scores, (45.28 ± 5.34) scores vs. (22.19 ± 4.19) scores, (4.46 ± 0.63) scores vs. (3.25 ± 0.66) scores, (39.54 ± 1.54) scores vs. (15.39 ± 2.86) scores, (3.45 ± 0.65) scores vs. (1.84 ± 0.32) scores;in control group:(28.16 ± 4.07) scores vs. (65.67 ± 6.22) scores, (93.03 ± 7.54) scores vs.(43.74 ± 7.57) scores, (44.65 ± 5.26) scores vs. (22.45 ± 4.37) scores, (4.74 ± 0.71) scores vs. (3.17 ± 0.59) scores, (39.87 ± 1.26) scores vs. (16.19 ± 2.55) scores, (3.77 ± 0.73) scores vs. (1.93 ± 0.43) scores, and there were significantly differences (P<0.05). There were no significantly differences between two groups (P>0.05). All patients were follower up for 12-36(23.19 ± 3.66) months. One case in observation group had leg swelling and healed after symptomatic treatment, 1 case in the control group had limb swelling, and 1 case had extensive subcutaneous bleeding .And they were cured after symptomatic treatment 1 case had femoral dislocation, and no secondary dislocation happened after the implementation of manual reduction. Conclusions Brachypodium ceramic ceramic total hip replacement therapy has same effect for young osteonecrosis patients compared to polyethylene and metal prosthesis in improving hip function, but the ceramic-on-ceramic prosthesis brachypodium has better performance in wear resistance with smaller friction coefficient is smaller, and is suitable for young patients.