陶瓷全髋假体在中青年患者行全髋关节置换术的中远期疗效

Mid- and long-term efficacy of ceramic-on-ceramic total hip arthroplasty in younger patients

目的探讨采用陶瓷对陶瓷摩擦界面全髋假体在中青年患者行全髋关节置换术（THA）的中远期疗效。方法回顾性分析2001年3月-2011年3月收治的中青年患者因股骨头坏死、先天性髋关节发育不良等行THA治疗72例，其中男40例，女32例；年龄（35．2±7．6）岁（17—45岁）。手术均采用生物学固定型假体，摩擦界面均采用陶瓷对陶瓷假体。采用Harris评分和美国加州洛杉矶大学（UCLA）标准评估患者的髋关节功能和活动水平，应用影像学检查评估假体松动、骨溶解和陶瓷假体相关并发症，并分析陶瓷假体的生存情况。结果随访时间[（8．5±2．4）年）5～12年]。术后Harris评分由术前（46．1±12．3）分（27—70分）提高至末次随访时（93．8±4．3）分（85～100分）（P〈0．05）。活动水平按UCLA标准，由术前（4．0±1．2）分（2—6分）提高至末次随访时（7．1±1．4）分（4—10分）（P〈0．05）。至末次随访时，无一例患者出现骨溶解或假体松动，2例（2髋）“三明治”陶瓷假体破碎，1例（1髋）发生髋关节脱位，1例（1髋）出现关节异响现象。以陶瓷破碎引起的翻修作为终极点，其平均8年生存率为97％（95％CI91．9～100．0）。结论陶瓷对陶瓷摩擦界面全髋假体可满足中青年患者对参加工作和运动的需求，且中远期疗效好。

Objective To evaluate the mid- and long-term clinic results of ceramic-on-ceramic joint in total hip arthroplasty （THA） in younger patients. Methods A retrospective review was made on 72 younger patients who had THA with ceramic-on-ceramic bearings due to femoral head necrosis or inborn hip dysplasia between March 2001 and March 2011. There were 32 females and 40 males, at a mean age of （35.2± 7.6）years （range, 17-45 years）. Patients were evaluated with Harris hip score and University of California, Los Angeles （UCLA） activity score. Radiological findings were recorded including component loosening, ostelysis, and ceramic bearing related complications. Results Duration of follow- up was （8.5± 2.4） years （range, 5-12 months）. At the final follow-up, Harris hip score was increased to （93.8 ±4.3 ）points （range, 85-100 points） compared to preoperative （46.1 ±12.3 ）points （range, 27- 70 points） and UCLA activity score was increased to （7.1± 1.4）points （range, 4-10 points） compared to preoperative （4.0±1.2）points （range, 2-6 points） （P 〈 0. 05 ）. At the final follow-up, no osteolysis or prosthesis loosening occurred, but there were ceramic sandwich liner fractures in two patients （ two hips）, dislocation in one patient （one hip） and squeaking in one patient （one hip）. After revision due to the ceramics break, the 8-year survival rate was 97% （95% CI 91.9-100.0）. Conclusion Ceramic- on-ceramic joint in THA satisfies the activity demand in younger patients, with excellent mid- and long- term clinical results.