采用陶瓷-陶瓷(Delta陶瓷)与陶瓷-高交联聚乙烯界面在全髋关节置换中的短期对比研究

Bearing Surfaces of Ceramic-on-Ceramic(Delta ceramic)Versusceramic-on-Highly Cross-Linked Polyethylene in Total Hiparthroplasty:A Short-term Comparative Study

目的通过临床和影像学随访,观察比较陶瓷-陶瓷(Delta陶瓷界面)与陶瓷-高交联聚乙烯界面在治疗髋关节疾病的短期临床疗效。方法回顾分析自2015年7月至2016年7月共65例(73髋)运用陶瓷对陶瓷(Delta陶瓷界面)和陶瓷对高交联聚乙烯生物型假体行初次全髋关节置换术患者的临床资料,根据关节摩擦界面配伍类型分为两组,即陶瓷对陶瓷组(CC组)和陶瓷对聚乙烯组(CP组)。对有效随访的患者通过X线片测量摩擦界面线性磨损率、髋臼外展角及其改变量,观察假体周围骨溶解及假体松动情况,应用Harris评分标准进行功能评价。结果共61例(69髋)患者获有效随访,平均随访时间26个月(24～30个月)。两组患者性别、年龄、体重、病因及术前Harris评分比较,差异均无统计学意义(P>0.05)。CC组假体的磨损因髋臼假体的遮挡而无法测出。CP组术后前两个月的位移值为(0.08±0.011)mm,从术后2～24个月的位移值为(0.017±0.012)mm。CC组Harris评分由术前平均(46.18±7.31)分提高到末次随访时(89.70±6.44)分(P<0.001);CP组Harris评分由术前平均(43.92±8.94)分提高到末次随访时(92.61±6.23)分(P<0.001)。两组间末次随访时Harris评分差异无统计学意义(P>0.05)。所有患者假体与骨之间界面X线片没有透亮带出现,均未出现假体松动。结论陶瓷-陶瓷(Delta陶瓷界面)与陶瓷-高交联聚乙烯界面在治疗髋关节疾病中均有较好的疗效,两种假体的临床疗效在关节置换术后早期并无明显差异。

Objective To compare the short-term clinical efficacy between ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearing surfaces in total hiparthroplasty. Methods 65 patients(73 hips) who accepted the ceramic-on-ceramic andceramic-on-highly cross-linked polyethyleneprimarytotal hiparthroplasty (THA) from July 2015 to July 2016 were retrospectively analyzed.Patients were divided into 2 groups:ceramic-on-ceramic group(CC group) and ceramic-on-highly cross-linked polyethylene group(CP group).X-ray film was measured to observe osteolysisandprosthesis loosening,and to measurelinear wear rate and the abduction angle of the acetabular cup.Harris score were used to evaluatethe hip function. Results Sixty-onepatients(69 hips)were followed up.The mean follow-up period was 26 months(ranged 24~30 months).There was no significant differencein gender,age,body weight,and preoperative Harris score between the two groups ( P >0.05).The wear rate in CC group could not be measured due to the occlusion of the acetabular cup.The mean displacement value of the first two months in CP group was (0.08±0.011)mm.The mean displacement value from 2 to 24 months after surgery was (0.017±0.012)mm.The mean Harris score of CC group increased from (46.18±7.31)(preoperative) to (89.70±6.44)(postoperative)( P <0.001).The mean Harris score of CP group increased from (43.92±8.94)(preoperative) to (92.61±6.23)(postoperative)( P <0.001).There was no significant difference in Harris score between the two groups at the last follow-up ( P >0.05).No radiological signs of osteolysis orprosthesis loosening were detected at follow-up. Conclusion Both ceramic-on-ceramic(Delta ceramic)and ceramic-on-highly cross-linked polyethylene bearing surfaces have good effect in the total hip arthroplasty.There is no significant difference between the two prostheses in the early postoperative period.