大直径股骨头金属-金属人工全髋关节置换术的中期疗效

Mid-term effectiveness of large-head metal-on-metal total hip arthroplasty

目的探讨大直径股骨头金属-金属人工全髋关节置换术(total hip arthroplasty,THA)的中期疗效。方法回顾性分析2009年4月—2010年6月收治并接受大直径金属-金属THA治疗40例(43髋)患者临床资料。其中男18例(20髋),女22例(23髋);年龄20～85岁,平均55.1岁。单髋37例,双髋3例。股骨头缺血性坏死14例(15髋),原发性骨关节炎6例(7髋),类风湿性关节炎4例(4髋),股骨颈骨折4例(4髋),先天性髋关节发育不良12例(13髋)。术前髋关节Harris评分为(38.51±5.62)分,美国加州大学洛杉矶分校(UCLA)评分为(4.21±1.43)分,疼痛视觉模拟评分(VAS)为(6.78±0.95)分。结果患者均获随访,随访时间6.7～8.3年,平均7.5年。术后切口均Ⅰ期愈合,无神经、血管损伤以及感染、关节脱位等并发症发生。末次随访时,Harris评分为(93.33±3.21)分、UCLA评分为(7.32±1.45)分,与术前比较差异均有统计学意义(t=51.753,P=0.000;t=23.232,P=0.000)。术后3例(3髋)发生大腿疼痛,其中1例出现软组织炎性假瘤。X线片复查示,髋臼外展角及前倾角分别为(46.5±3.2)、(14.8±3.6)°;股骨柄假体初始稳定质量按照Mulliken标准评定,获优39髋、良4髋。随访期间,2髋发生骨溶解,其中1髋继发假体松动行翻修术;其余患者假体无松动、下沉。结论大直径股骨头金属-金属THA治疗髋关节终末疾病中期疗效良好。

Objective To explore the mid-term effectiveness of large-head metal-on-metal total hip arthroplasty （THA）. Methods A retrospective analysis was made on the clinical date of 40 patients （43 hips） who were treated with the large-head metal-on-metal THA between April 2009 and June 2010. There were 18 males （20 hips） and 22 females （23 hips） with an average age of 55.1 years （range, 20-85 years）. Unilateral hip was involved in 37 cases and bilateral hips in 3 cases. The disease causes included osteonecrosis of the femoral head in 14 cases （15 hips）, osteoarthritis in 6 cases （7 hips）, rheumatoid arthritis in 4 cases （4 hips）, femoral neck fracture in 4 cases （4 hips）, and developmental dysplasia of the hip in 12 cases （13 hips）. Before operation, the Harris score and University of California Los Angeles （UCLA） score were 38.51±5.62 and 4.21±1.43, respectively. The visual analogue scale （VAS） score was 6.78±0.95. Results All patients were followed up 6.7-8.3 years （mean 7.5 years）. All incisions healed primarily and no neurovascular injury, infection, and hip dislocation occurred. At last follow-up, the Harris score and UCLA score were 93.33±3.21 and 7.32±1.45, respectively, showing significant differences when compared with preoperative scores （t=51.753, P=0.000; t=23.232, P=0.000）. The thigh pain occurred in 3 cases （3 hips） in whom the inflammatory pseudotumor of soft tissues was found in 1 case （1 hip）. Postoperative X-ray films showed that the acetabular abduction angle and anteversion angle were （46.5±3.2）% and （14.8±3.6） %, respectively. The initial stability of femoral stem prosthesis was excellent in 39 hips and good in 4 hips according to Mulliken standard. Osteolysis occurred in 2 hips and revision was performed in 1 hip of secondary loosening of prosthesis. The rest patients had no prosthesis loosening or sinking. Conclusion The mid-term effectiveness of largehead mental-on-mental THA in treatment of the terminal diseases of hips are good.