晚期股骨头坏死的人工关节置换术

目的]探讨晚期股骨头坏死患者髋关节置换术的选择方法及其临床结果。方法]对本科于1985年5月～2003年12门行髋关节置换术的119例（138髋）股骨头坏死患者进行了随访。使用人工双极股骨头置换术及THA治疗晚期股骨头坏死者分别为29例（31髋），90例（107髋）。所有手术均采用后外侧人路。结果]早期使用的国产骨水泥人工双极股骨头假体，86．7％的股骨柄假体出现松动。全骨水泥THA，50％髋出现了髋臼杯似体松动，62．5％髋股骨柄似体松动，25％髋行全髋人工关节翻修术：混合型（Hybrid）THA，未出现髋臼杯及股骨柄似体的松动，非骨水泥THA，除1例外无髋臼杯及股骨柄假体松动或下沉。结论]使用人工双极股骨头置换术治疗晚期股骨头坏死应慎重选择，可适用于老年、日常活动量小的患者；而对于年轻患者，非骨水泥型THA为最佳选择；对于股骨侧出现骨质疏松或不适合使用生物固定型股骨柄假体的患者，混合型（Hybrid）THA同样可以获得满意疗效；全骨水泥犁THA应很少使用。

Arthroplasty for late osteonecrosis of the femoral head

Objective]To explore the methods and clinical results of artificial joint replacement for patients with late osteonecrosis of the femoral head.Method]A total of 119 patients(138 hips)who underwent replacement of hip joint from May 1985 to Dec.2003 were followed up.There were 29 patients(31 hips)and 90 patients(107 hips)using bipolar and total hip arthroplasty(THA)respectively.Result]In cases with cemented bipolar replacement,loosening occurred in 86.7 percent of femoral components.In cemented THA,loosening occurred in 50 percent of socket and 62.5 percent of femoral components.While no loosening of socket and femoral components appeared in all hybrid THA and in non-cemented THA except one.Conclusion]It must be careful to treat patients with late osteonecrosis of the femoral head using bipolar replacement and only for the old patients with less activities.Cementless THA is of choice for younger patients.Good results can be obtained by hybrid THA for patients with osteoporosis or for whom biologically fixed femoral component can not be used.All cemented THA should rarely used now.