为台湾地区居民体型设计的人工髋关节的临床应用

目的探讨股骨近端楔型直柄设计的人工髋关节假体在临床应用中的效果。方法本研究随访1995至1997年间，39例患者接受非骨水泥固定式全人工髋关节手术（44个假体，台湾联合骨科器材公司）的术后临床结果，其随访时间皆超过5年。结果截至最后一次的随访，Harris髋关节评分的平均值为96分，其中有1例患者死亡。同时，根据患者的个人感受，将术后结果进行评分，区分为优、良、差三个等级。其中，评为“优”有40例，“良”有3例，“差”有1例。44例患者中，39例没有产生痛觉，5例有轻微的痛觉，但这些患者均表示轻微的痛觉可以忍受，并且不需进行额外的医疗处置。由X线片观察股骨柄假体与骨髓腔的匹配情况发现，86％的患者在股骨干近端与远端皆可达到匹配，6％的患者在股骨干近端可达匹配，只有8％的患者无法达到形貌吻合，其中包含2例翻修的手术患者。另外，所有患者均无出现髋关节假体不稳定的现象或是磨损颗粒引起的组织反应，只有少量的射线可透性在股骨柄非珠结涂布区被观察到。由X线片观察髋臼杯假体结果发现，骨骼生长自术后第3个月开始即为良好，而且此骨骼生长情况持续到现在。在所有的患者中，也没有迹象显示髋臼杯有松脱、假体移位或是射线可透性。只有1例患者的髋臼在Charnley区域Ⅱ的位置发生反应纹路的现象。结论符合台湾地区居民体型设计的人工髋关节假体中期临床结果尚．称满意。

Clinical application of THA with a proximally tri-wedged straight femoral stem designed for Chinese in Taiwan

Objective This study reported the results of THA with a proximally tri-wedged straight femoral stem designed for Chinese after at least 5 years of follow-up in Taiwan.Methods The 44 hips of an uncemented total hip prosthesis(United U1 hip system, United Orthopedic Corp., Hsinchu, Taiwan) were implanted between 1995 and 1997 in 39 patients. All were followed up for more than 5 years.Results At the last follow-up, one patient died, the mean Harris hip score was 96, 40 hips were graded as excellent, 3 as good and 1 as poor. 39 hips had no pain and 5 had slight pain including 2 had thigh pain, but all patients could tolerate the pain without medication. The radiological findings revealed initial metaphyseal and diaphyseal fit and fill in 86% of cases, metaphyseal fit and fill in 6%, only 8% of cases(including 2 revision cases) need cementing of stem. There were no sign of instability, particularly, reactive line in stem. The radiolucency had observed only in small amount of non-porous coated area of stem. In acetabulum, the host bone in direct contact with the implant was normal in 3 Charnley zones from the third month and this normal pattern was maintained throughout the final follow up. There was no evidence of instability, nor implant migration and radioluciencies around the cup. There was only one case showed reactive line around the zone Ⅱ acetabular component in the revision case of acetabular protrusion, grafting was used to fill the excoriated fovia.Conclusions From this study, the midterm results of United hip prosthesis in variable disease categories and age group was quite favorable