有髋部外伤史患者的第四代陶瓷-陶瓷界面全髋关节置换术的长期疗效

Long-term results of total hip arthroplasty with 4th ceramic-on-ceramic bearing for patients with history of hip injury

目的:探讨有髋部外伤史患者采用第四代陶瓷-陶瓷界面(ceramic-on-ceramic,CoC)全髋关节置换术的长期临床疗效。方法:回顾性分析2008年12月至2011年12月行第四代CoC界面生物型全髋关节置换术、有髋部外伤史且随访8年以上的患者128例(132髋),男87例、女41例,年龄(49.26±14.18)岁(范围17~76岁)。病因为创伤性髋关节炎50髋、股骨头坏死74髋、股骨颈骨折8髋。髋部外伤包括:髋臼侧骨折15髋(11.4%)、股骨侧骨折90髋(68.2%)、髋关节脱位5髋(3.8%)、其他或不明确骨折部位22髋(16.7%)。记录手术时间、末次随访时评估髋关节Harris评分、髋关节活动度、术后并发症和关节异响等情况,采用Kaplan-Meier生存分析评估假体十年生存率。结果:手术时间(135.61±41.65)min(范围64~320 min)。随访时间(9.62±0.82)年(范围8.2~11.3年)。Harris髋关节功能评分由术前(44.07±19.71)分提高至末次随访的(94.03±4.10)分,差异有统计学意义(t=24.155,P<0.001);髋关节活动度由术前75.90°±28.05°提高至117.14°±12.36°,差异有统计学意义(t=13.176,P<0.001)。不同外伤病因(车祸伤、摔伤、扭伤、其他)及不同骨折部位(髋臼侧骨折、股骨侧骨折、髋关节脱位)组手术前后Harris评分、髋关节活动度的差异均无统计学意义(P>0.05)。术后出现假体周围骨折1髋(0.8%,1/132)、关节脱位2髋(1.5%,2/132),随访期间无假体周围感染或陶瓷界面碎裂发生;髋关节异响13髋(9.8%,13/132),包括摩擦音9髋(6.8%,9/132)和咔哒音4髋(3.0%,4/132),均未引起髋部疼痛及影响生活,未行处理。关节假体十年生存率为100%;以再手术为终点,生存率为99.24%(95%CI:97.8%,100%)。结论:采用第四代CoC界面全髋关节置换术治疗有髋部外伤史的患者长期疗效满意。术后髋关节异响发生率约为10%,但对髋关节功能和患者生活质量没有明显影响。

Objective To evaluate the long-term clinical outcomes of total hip arthroplasty with the 4th ceramic-on-ceramic bearing in patients with history of hip injury.Methods During December 2008 to December 2011,a total of 153 patients(157 hips)with history of hip injury were treated with 4th ceramic-on-ceramic bearing total hip arthroplasty.There were 25 cases(25 hips)were not followed up(16.3%).Ultimately,a total of 128 cases(132 hips)aged 49.26±14.18(range 17-76)years including 87 males and 41 females were included in the study.In these patients,there were 15 cases(11.4%)with acetabular fracture,90 cases(68.2%)with femoral fracture,5 cases(3.8%)with hip dislocation and 22 cases(16.7%)with unknown history.Clinical outcomes,including operation duration,Harris score,range of motion,complications and noises,were evaluated.The survivorship was investigated by using Kaplan-Meier method.Results The operation duration was 135.61±41.65(range 64-320)min.The average follow-up duration was 9.62±0.82(range 8.2-11.3)years.The Harris score increased from preoperative 44.07±19.71 to 94.03±4.10 at the last follow-up(t=24.155,P<0.001).The range of hip motion increased from 75.90±28.05 degrees to 117.14±12.36 degrees(t=13.176,P<0.001).There was no significant difference in Harris scores and ranges of motion among the groups with different history of fracture and dislocation.There were periprosthetic fracture in 1 case and hip dislocation in 2 cases.There was no periprosthetic hip infection or fracture of ceramic liner during the follow up.Thirteen cases(13 hips,9.8%),including squeaking in 9 cases(6.8%)and clicking in 4 cases(3.0%),reported hip noise without pain and impairment on the quality of life.The survivorship was 100%at 10 years when regarded revision as an end point.However,the survivorship was 99.24%(95%CI:97.8%,100%)at 10 years when reoperation revision as an end point.Conclusion Total hip arthroplasty with 4th ceramic-on-ceramic bearing could have excellent results for patients with a history of hip fracture or dislocation in the long-term follow-up.Although the prevalence of hip noise was about 10%in this cohort study,there was no impairment on the quality of life.