非骨水泥型全髋人工关节置换治疗髋部骨关节炎的临床和影像学研究

OUTCOMES OF CEMENTLESS TOTAL HIP REPLACEMENT IN TREATMENT OF OSTEOARTHRITIS

目的 评价非骨水泥型全髋人工关节置换治疗髋部骨关节炎的临床及影像学结果 ,分析影响其中长期疗效的主要因素。 方法 回顾分析 1995年 1月～ 1999年 12月 ,采用非骨水泥型全髋人工关节置换治疗髋部骨关节炎 93例 ,男 36例 ,女 4 0例。手术时年龄 4 0～ 73岁 ,平均 5 6 .4岁。合并糖尿病 3例 ,高血压 9例 ,冠心病 7例。术前髋关节功能 Harris分值 12～ 5 6分 ,平均 37.2分。获得随访 76例 85髋 ,随访时间 30～ 86个月 ,平均 4 9.3个月。随访时均进行 Harris评分、髋关节及股骨上段正侧位 X线片复查。 结果 术后并发脱位 1例 ,深静脉栓塞 2例 ,均经保守治疗治愈。无 1例出现局部感染 ,所有患者均安全渡过手术期和围手术期。随访时 Harris评分平均为 90 .9分 ,优良率为91.9%。 2 3髋 (2 7.5 % )诉大腿上段痛 ,14髋 (16 .5 % )有股骨近段骨吸收溶解 ,2髋 (2 .4 % )出现松动 ,股骨柄假体内翻置入时 Harris评分较低。 结论 非骨水泥型全髋人工关节置换治疗髋部骨关节炎的中长期疗效满意 ,部分患者大腿痛可能与股骨柄内翻位固定和股骨近段骨溶解有关 ,股骨近段骨溶解是影响长期疗效的主要因素。

Objective To evaluate the clinical results of cementless total hip replacement (THR) in treating osteoarthritis and identifying the factors affecting the results. Methods From January 1995 to December 1999, 76 patients(85 hips) with osteoarthritis of hip joint were treated. These patients were assessed according to Harris hip score and X-ray film. The average follow-up time was 49.3 months. Results The average Harris score in the patients was 90.9 points. The excellent or good rate was 91.9%(75/85). Pain in the thigh existed in 23 hips(27.5%). The femoral osteolysis occurred in 14 hips(16.5%). The radiographical result demonstrated femoral loosening in 2 hips. Harris score became lower when the femoral component was placed in varus position. Conclusion Cementless THR has been applied successfully to treatment of osteoarthritis of hip joint. Pain in the thigh may be related to the varus placement of femoral component and femoral osteolysis. Femoral osteolysis is one of important factors affecting the long-term outcomes.