改进型Tri—lock骨保留假体的短期临床应用研究

目的 评价改进型Tri lock骨保留假体在初次全髋关节置换术中的应用,分析这种改进型假体的稳定性及临床效果.方法 选取2011年3月到2012年3月本组接受初次全髋关节置换术治疗的患者36例（37髋）,男5例,女31例;年龄48～71岁,平均年龄54岁.新鲜股骨颈骨折5例、5髋.股骨头坏死Ⅲ期6例、6髋,Ⅳ期7例、7髋.DDH CroweⅠ型继发髋关节骨关节炎5例（6髋）,Ⅱ型继发髋关节骨关节炎2例（2髋）.原发性髋关节骨关节炎11例（11髋）.髋臼假体全部采用生物型假体,内衬采用陶瓷内衬的27髋,采用金属内衬的10髋,股骨头全部采用陶瓷头.手术均采用髋关节后外侧切口,术后3、6、12个月及以后每年随访一次,采用Harris髋关节评分和骨性关节炎指数可视化量表（WOMAC）,对患者手术前后关节功能进行评估.结果 36例患者（37髋）全部获得随访,随访时间范围15～27个月,平均随访时间 24.8个月.Harris髋关节评分从术前平均（20.33±10.40）分提高到末次随访时的（93.96±4.45）分,手术前后差异有统计学意义（t=28.37,P〈0.01）.骨关节炎指数（WOMAC）评分改善显著,总分由术前（77.41± 13.07）分降至末次随访时的（11.53±4.56）分,手术前后差异有统计学意义（t=21.37,P〈0.01）.随访期间未发现假体松动,脱位及感染.结论 由于假体本身设计特点,更加符合身高较矮、骨骼较小的亚洲人,其次可以保留更多的骨量,假体初始稳定性好,陶瓷-陶瓷界面或陶瓷-金属界面磨损率低,近期疗效好,并发症少,易于二次翻修.

Short term clinical study on improved Tri lock bone retaining prosthesis

Objective To evaluate the clinical effects of the improved Tri lock bone retaining prosthesis in the primary total hip replacement, and to clarify whether it can improve the stability of the prosthesis. Methods From March 2011 to March 2012, 36 cases （37 hips） underwent the primary total hip arthroplasty, including five males and 31 females. The age ranged from 48 years to 71 years, 54 years in average. There were five cases of fresh femoral neck fracture, six cases of the femoral head necrosis in stage Ⅲ, seven cases of the femoral head necrosis in stage Ⅳ, five cases of DDH in CroweⅠ, two cases of DDH in CroweⅡ, and 11 cases of the primary osteoarthritis of the hip. The acetabular prostheses were all biological prosthesis, with the ceramic lining in 27 cases and the metal lining in 10 cases. The ceramic femoral head was used in all the cases. The posterior lateral hip incision was adopted in the surgery. The follow up was carried out in 3, 6, 12 months after the surgery, and later once a year. The Harris score system and the osteoarthritis index （WOMAC） were used to assess the joint function of the patients before and after the surgery. Results All the patients were full followed up, and the follow up time was 15 months to 27 months, with an average of 24.8 months. The Harris score increased from preoperative （20.33±10.40） to （93.96±4.45） at the end of the follow up. The osteoarthritis index （WOMAC） score improved significantly： the total score dropped from preoperative （77.41±13.07） to （11.53±4.56） at the last follow up. There was a statistically significant difference. There was no implant loosening, dislocation or infection was observed during the follow up. Conclusions The design of the prosthesis is more suitable for the smaller bones of Asians. The improved Tri lock of bone retaining prosthesis can preserve more bone mass, provide a good initial stability of the prosthesis, with a low rate of the ceramic interfaces wearing. It has good therapeutic effects in shor term, with fewer complications, and it will be easily renovated for the second time.