金属对金属髋关节表面置换63例随访评价

背景:随着制作假体T艺和于术技术的改进,髋关节表面置换后假体早期松动和股骨颈骨折等情况很少发生,能得到更佳的髋关节活动功能.目的:观察髋关节表面置换后材料与宿主的生物相容性及髋关节功能恢复情况.设计、时间及地点:回顾性病例分析,于2006-01/2007-08在解放军第二军医大学长海医院骨科进行.对象:52例髋关节疾病患者完成63侧髋关节表面置换,其中11例患者做了一期双侧置换.女25例,男27例,平均年龄47.6岁.方法:假体由Zimmer公司提供,髋关节以标准4mm厚非骨水泥型髋臼(金属臼杯厚3.7mm,外覆0.3mm等离子钛涂层)进行重建.髋臼杯是大直径、半圆形(165°),外覆等离子钛涂层用以非骨水泥固定.采用后外侧入路,髋臼假体均放置在髋关节解剖中心的位置,且覆盖髋臼假体面积超过90%以上.主要观察指标:①记录置换后脱位、感染等材料与宿主的生物相容性反应.②置换后1,3,6,12个月及其后每年一次采用Harris髋关节评分系统进行功能评估.③影像学资料按照DeLee和Charnley描述的区域,记录髋臼杯周围厚度>1mm的放射线可透区.结果:①所有患者均得到随访,没有发生脱位、没有明显临床症状并需治疗的深静脉栓塞、深部感染或神经血管并发症.②Harris髋关节评分置换前平均38分,置换后平均90分,较术前显著改善.③有2例患者置换后观察到髋臼假体底2mm的间隙,置换后6个月消失.没有发现髋臼或股骨假体的迁移或局部的骨溶解.结论:金属-金属髋关节表面置换治疗年轻及活动量较大患者早期随访结果较好,无特殊生物相容性反应,置换后获得了较佳的髋关节活动功能和骨量保留.     

Revision of failed metal-on-metal total hip arthroplasty using cemented arthroplasty: a mean 10-year follow-up of 157 consecutive patients

ObjectiveThis study was performed to assess the outcomes of Asian patients who underwent conversion from metal-on-metal total hip arthroplasty (MoM-THA) to cemented THA (CTHA).MethodsOne hundred and fifty-seven consecutive patients (157 hips) who underwent CTHA following primary MoM-THA from January 2005 to February 2015 were retrospectively analysed. The primary endpoints were the clinical outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every 2 years following revision of MoM-THA.ResultsThe mean follow-up after conversion was 10 years (range, 5–14 years). Statistically significant improvements in the mean Harris hip score were observed between the preoperative and final follow-up evaluations (62.71 ± 13.85 vs. 84.03 ± 16.21, respectively). The major orthopaedic complication rate was 16.5% (26/157). Six (3.8%) patients underwent revision at a mean of 3.5 ± 1.3 years after conversion, predominantly because of prosthesis loosening or recurrent dislocation. Nine (5.7%) patients developed prosthesis loosening at a mean of 2.6 ± 1.1 years following conversion, two of whom requested revision surgery. Eleven (7.0%) patients developed prosthesis dislocation, four of whom requested revision surgery.ConclusionCTHA may yield favourable functional outcomes and a reduced rate of major orthopaedic complications.     

大头金属-金属髋关节假体与普通全髋关节假体置换效果比较:1年随访

背景:传统髋关节置换最常见的并发症是置换后髋关节脱位,而大头关节能有效地解决这一问题.目的:观察大头金属-金属髋关节置换假体临床应用的疗效.设计、时间及地点:前瞻性队列研究,病例来自2007-02/2008-01新疆维吾尔自治区中医医院关节外科.对象:选择新疆维吾尔自治区中医医院关节外科收治的行大头金属-金属全髋关节置换的患者65例(71髋),男44例,女21例;年龄19～77岁,平均54.6岁;其中股骨头坏死28例,髋关节骨性关节炎24例,股骨颈骨折9例,髋臼发育不良4例.方法:按照年龄、性别、病因及术前关节功能等将患者分为两组:普通假体组30例(33髋),大头金属-金属髋关节组35例(38髋).大头组假体采用Depuy公司生产的第4代金属-金属全髋关节置换系统(ASR/XL);普通假体组为普通金属-聚乙烯全髋关节置换假体.主要观察指标:记录并比较两组置换前/置换后髋关节Harris评分,髋关节活动范围,X射线假体周围透亮带,双下肢不等长及置换后并发症等指标.结果:所有病例均获随访,普通假体组随访13～28个月,平均20个月;大头金属-金属髋关节组随访10～26个月,平均17个月.①两组患者置换后末次随访普通假体组Harris髋关节评分59～98分,平均89分;大头金属-金属髋关节组71～100分,平均94分,两组相比,差异有显著性意义(P=0.014).②髋关节动度范围的提高,在置换后6个月大头金属-金属髋关节组34°优于普通假体组26°(P=0.004);最终随访1年以上,活动范围在普通假体组提高27°,大头金属-金属髋关节组为37°,两组相比,差异有显著性意义(P=0.009).③双下肢不等长差值大头金属-金属髋关节组平均4 mm(2～11 mm),普通假体组为7 mm(5～16 mm),两组相比,差异有显著性意义(P=0.005).④两组均有≤1 mm假体周围透亮带发生(普通假体组2例,大头金属-金属髋关节组3例);普通假体组有1例脱位.结论:与传统全髋关节假体相比,大头金属-金属髋关节假体治疗髋关节疾病短期疗效肯定,置换后获得了更好的髋关节功能,同时髋关节更加稳定.     

非骨水泥型髋关节假体用于老龄初次全髋关节置换:2年随访

背景:目前普遍认为非骨水泥型假体适用于年龄< 65岁的患者,骨水泥假体适用高龄、骨质情况欠佳的患者.但没有明确证据表明非骨水泥假体不适用于年龄> 70岁、既往身体健康、日常活动量满意、无骨质疏松或有轻度骨质疏松的患者.目的:观察非骨水泥型髋关节假体用于老龄初次全髋关节置换患者的效果.方法:纳入行非骨水泥假体初次全髋关节置换、年龄> 70岁的老龄患者57例65髋,平均年龄86.3岁;其中股骨颈骨折33例33髋,股骨头缺血性坏死18例25髋,髋关节发育不良6例7髋.记录置换时间、手术出血量、住院时间、置换后初次下床活动的时间、置换前及置换后3,6,12,24个月的髋关节Harris评分、X射线片结果、置换后并发症.结果与结论:随访6～40个月,平均19.6个月.53例完成随访,4例失访,未发现假体松动和需翻修手术病例.Harris评分由置换前的平均(40.7±18.9)分提高到置换后的(89.2±5.5)分,优良率为93.7%.置换后并发症包括术口血肿1例、脑血管意外1例几泌尿系感染1例.提示老龄患者用非骨水泥型髋关节假体行初次全髋关节置换治疗能达到满意的近期效果.     

人工髋关节置换48例5年随访

选择1998-01,2007-12兰州市第一人民医院进行人工髋关节置换48例患者.其中人工股骨头置换27例,人工全髋关节置换21例.平均随访5年,2例置换后3～7 d发牛脱位,1例置换后6个月发生感染疼痛,3例置换后2.0～3.0年发生松动疼痛.其他病例功能明显改善,关节活动基本正常,X射线片示假体位置满意.提示合理选择人工关节假体,防治术后感染、脱位、假体松动等材料与宿主的组织相容性反应是提高假体置换成功率,延长假体寿命的必要条件.     

金属对金属髋关节表面置换后的有限元分析

背景:与全髋关节置换相比,髋关节表面置换术有着诸多优势,如保留股骨头、股骨颈,方便于日后翻修,保存了股骨近端的生理力学分布,已成为年轻或对髋关节活动度要求较高的髋关节骨关节炎终末期患者更具吸引力的手术治疗方式.目的:观察人工髋关节表面置换术后殷骨及假体的应力分布.设计、时间及地点:单一样本观察,于2007-09/2008-04在南方医科大学解剖及生物力学实验室完成.对象:选择南方医科大学珠江医院收治的行金属对金属髋关节表面置换术男性患者1例(自愿参与实验),年龄40岁,检查排除健侧髋关节疾患.方法:建立股骨和假体有限元模型,分析在步行峰值关节载荷作用下,表面置换术后股骨颈及假体的应力水平.主要观察指标:股骨侧与假体的应力.结果:①髋关节表面置换术后股骨受力总体模式不变,股骨颈存在应力遮挡.应力峰值存在于股骨颈基底部,与其他区应力值相比,差异具有显著性意义(P<0.001),特别是转子窝附近以及骨-假体界面.②假体应力分布:应力峰值存在于髋臼及股骨假体外上方、髋臼杯沿与股骨假体交界处以及骨-假体界面.结论:髋关节表面置换术后股骨受力总体模式不变,股骨颈存在应力遮挡.峰应力存在于股骨颈基底部及骨-假体界面,为了减少术后股骨颈骨折的发生率,术中应特别加以保护上述区域.     

大直径金属对金属全髋关节假体置换49髋随访分析

背景:传统全髋关节置换在年轻、活动量高的患者中有较高的早期失败率.大直径金属对金属全髋关节置换具有杰出的稳定性、低磨损性,成为解决上述问题的一个重要选择.目的:评价大直径金属对金属全髋关节置换术的临床效果. 方法:2007-04/2009-10常州市中医医院骨科对48例49髋股骨头缺血性坏死、骨关节炎、强直性脊柱炎、髋关节发育不良、股骨颈骨折及其并发症患者进行了大直径金属对金属全髋关节置换.置换后的髋关节功能采用Hams标准评定,每一例患者摄标准的骨盆平片,观察假体位置,比较置换后随访X射线平片的变化.结果与结论:全部患者均获得随访,时间3～34个月,平均20.2个月.患者置换后无脱位,无感染,无髋臼及股骨骨折.2例髋臼假体周围发现透亮带.1例出现腹股沟区疼痛.2例出现关节周围响声.最近一次随访Harris平均评分96分,优良率100%.提示大直径金属对金属全髋关节置换可有效的治疗股骨头缺血性坏死、骨关节炎、强直性脊柱炎、髋关节发育不良、股骨颈骨折及其并发症,近期随访结果满意.     

Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty

Metal-on-metal (MOM) bearing surfaces in hip arthroplasty have distinct advantages that led to the increase in popularity in North America in the early 2000s. However, with their increased use, concerns such as local cytotoxicity and hypersensitivity reactions leading to soft tissue damage and cystic mass formation (known collectively as adverse local tissue reactions (ALTR)) became apparent. The clinical presentation of ALTR is highly variable. The diagnosis of ALTR in MOM articulations in hip arthroplasty can be challenging and a combination of clinical presentation, physical examination, implant track record, component positioning, serum metal ion levels, cross-sectional imaging, histopathologic analysis, and consideration of alternative diagnoses are essential.     

Müller curved-stem total hip arthroplasty: long-term follow-up of 185 consecutive cases

We reviewed 185 consecutive Müller total hip arthoplasties ten to 14 years after operation. Of the 32 patients with 42 arthroplasties who had died within the ten-year period, three had had revisions and five had died of causes related to the operation, including two late infections. Sixty-five hips in 56 living patients were available for clinical and roentgenographic evaluation. An additional 30 hips had been revised for various reasons. When the roentgenographically loose components were combined with the revised ones, the overall incidence of aseptic loosening was 40% for the femoral component and 12.6% for the acetabular component. As previously reported, the combined incidence of loose and revised components at 6 1/2 years was 27.7% for the femoral component and 3.2% for the acetabular component. Therefore, in the intervening five years, the rate of femoral loosening remained about the same, while the rate of acetabular loosening increased. There was a positive correlation between the incidence of loosening of the femoral component and male sex, deficient cementing, and varus position. There was no significant wear of the acetabular component.     

大直径金属-金属全髋关节置换的早期疗效

背景:髋关节置换后脱位仍然是传统的金属对聚乙烯全髋关节置换的主要并发症之一,大直径金属对金属的全髋关节置换后具有良好的稳定性,适合年轻、活动要求高的患者。目的:验证大直径金属-金属全髋关节置换治疗终末期髋关节疾病的早期疗效。方法:回顾性分析48例(54髋)初次大直径金属-金属全髋关节置换后的早期临床疗效。假体股骨头直径平均为44mm(38～48mm),采用Harris评分和X射线检查评估早期疗效。结果与结论:所有患者都获得18～36个月随访,末次随访Harris评分平均93.6分(91～96分),疗效评价为优。末次随访时髋关节总活动度平均为232.6°(182～257°),置换后髋关节总活动度明显增大。所有患者切口均Ⅰ期临床愈合,无髋部和大腿疼痛、感染、关节脱位、血管、神经损伤等并发症,置换后X射线片示假体位置良好,无松动或下沉。提示大直径金属-金属全髋关节置换治疗终末期髋关节疾病具有早期低磨损、髋关节的活动度好、脱位率低等优点。