双动全髋关节假体置换术的中期疗效

Mid-term clinical outcomes of the dual mobility total hip prosthesis in primary total hip arthroplasty

目的探讨采用双动全髋关节假体的初次髋关节置换术的中期疗效。方法回顾性分析2010年5月至2013年3月采用双动全髋关节假体初次全髋关节置换术且有完整随访资料的患者101例,男45例,女56例;年龄(66.36±5.48)岁(范围58~77岁)。初次髋关节置换术的病因为股骨颈骨折35例、股骨头坏死33例、髋关节骨关节炎10例、髋关节发育不全继发骨关节炎18例、强直性脊柱炎5例。均采用髋关节后外侧入路,假体为双动全髋关节假体。术后评估Harris髋关节评分,观察假体的生物学固定效果、假体内脱位、骨溶解及髋臼杯的迁移情况。结果手术时间(80.68±6.59)min(范围70~90 min),术中出血量(180.67±18.76)ml(范围150~200 ml),切口均一期愈合。随访时间(65±3)个月(范围62~75个月)。Harris髋关节评分由术前(56.70±16.71)分提高至术后6个月的(94.17±1.88)分、术后1年的(94.18±1.89)分、术后3年的(94.24±1.95)分及末次随访的(94.26±1.91)分,不同随访时点的差异有统计学意义(F=448.38,P=0.00)。髋关节屈伸、内收外展和内旋外旋活动度分别为141.73°±6.56°、57.06°±3.83°、75.18°±4.00°,均较术前(分别为86.67°±16.70°、34.06°±7.05°、34.53°±7.45°)增加。术后3个月X线片显示骨整合良好,术中未发生髋臼和股骨干骨折、坐骨神经和股动静脉损伤,随访期间无关节脱位、感染及下肢深静脉血栓形成等并发症。髋臼杯在水平方向和垂直方向没有明显的迁移,18例有骨溶解的患者均无症状。结论双动全髋关节假体可提供良好的初始稳定性及中期稳定性,骨长入快,假体脱位率低,术后运动范围恢复良好,适用于65岁以上及有高术后脱位风险的较年轻的患者。

Objective To investigate the mid-term outcomes of the dual mobility total hip prosthesis in primary total hip arthroplasty. Methods A total of 101 patients who underwent primary total hip arthroplasty with dual mobility total hip prosthesis from May 2010 to March 2013 were enrolled in the present study with complete follow-up information. There were 56 females and 45 males with the mean age of 66.36 years (rang from 58 to 77 years). There were 35 patients with femoral neck fracture, 33 patients with femoral head necrosis, 10 patients with hip osteoarthritis, 18 patients with secondary osteoarthritis to hip dysplasia and 5 patients with ankylosing spondylitis. The dual mobility total hip prosthesis was used for all 101 patients by the posterior-lateral approach of hip joint. Harris hip score was used to evaluate the clinical effects. Radiographic analysis was also performed to evaluate the biological fixation effects of the prosthesis, dislocation of the prosthesis, osteolysis and migration of the acetabular cup. Results The mean operation duration was 80.68±6.59 min (range from 70 to 90 min). The average blood loss during the operation was 180.67±18.76 ml (range from 150 to 200 ml). All incisions were healed at the first stage. All patients were followed up with an average of 65±3 months (range from 62 to 75 months). Harris hip score improved from 56.70±16.71 before surgery to 94.26±1.91 at the last follow-up. The differences among different follow-up times were of statistical significance. The Hip flexion and extension, adduction and abduction, and internal and external rotation improved from 86.67°±16.70°, 34.06°±7.05°, 34.53°±7.45° preoperatively to 141.73°±6.56°, 57.06°±3.83°, 75.18°±4.00° at the last follow-up, respectively. At 3 months after the operation, the X-ray showed satisfied bone integration. There were no acetabular and femoral shaft fractures, sciatic nerve, femoral artery and vein injuries during the operation, and no joint dislocation, prosthesis loosening, infection and deep venous thrombosis of lower limbs during the postoperative and follow-up duration. Conclusion The dual mobility total hip prosthesis has the advantages in good initial and middle stability, rapid bone growth, low dislocation rate and repid recovery of postoperative motion range. It is suitable for patients over 65 years old or younger patients with postoperatively high dislocation.