单纯聚乙烯内衬更换在髋关节翻修手术中的应用

目的探讨聚乙烯内衬磨损而髋臼金属杯仍然同定良好者进行单纯髋臼内衬更换的技术和疗效。方法瑞金医院徉2003年2月至2007年3月期间,对16例HGⅡ型髋关节进行单纯内衬翻修手术,患者平均年龄63岁（51～82岁）,距离初次手术时间平均6．2年（3～8年）。5例出现髋臼内衬脱位,3例出现髋臼金属假体周围骨吸收。术前Harris评分81．7分（56～91分）。所有患者术中取出磨损髋臼内衬后,清除髋门内肉芽组织后,用骨水泥同定新的聚乙烯假体。3例假体周围骨吸收患者通过金属假体螺钉孔对缺损区域进行了异体骨打压植骨。结果16例髋关节术后随访2—6年,X线检查聚乙烯-骨水泥-金属杯界面没有松动迹象。3例髋臼金属杯周围植骨患者植骨愈合。随访中未发现感染及髋关节脱佗。髋关节了Harris评分87．6分（76～92分）。结论单纯聚乙烯内衬翻修具有手术操作简单、避免了金属杯取出继发髋臼骨缺损的优点。术后随访湿示患者功能恢复良好、聚乙烯假体固定牢固。     

初次人工全髋关节置换术中髋臼骨折的原因及处理

目的探讨初次行人工全髋关节置换术(total hip arthroplasty,THA)术中发生髋臼骨折的原因和处理方法。方法 2005年5月-2008年7月,9例9髋初次行THA患者术中发生髋臼骨折。男1例,女8例;年龄41～73岁,平均63.3岁。发育性髋关节发育不良4例,类风湿性关节炎2例,陈旧性股骨颈骨折1例,股骨头缺血性坏死1例,强直性脊柱炎1例。病程1～35年,平均19.5年。左髋3例,右髋6例。Harris评分为(40.4±2.9)分。患者均选择非骨水泥型假体。术中发生髋臼前壁骨折2例,后壁骨折6例,均属稳定型骨折,1例未作特殊处理,余7例给予3～4枚螺钉加强固定;后壁骨折伴后柱不全骨折1例,属不稳定型骨折,给予髋臼杯底植骨联合3枚螺钉固定。结果术后X线片检查示假体位置良好。切口均Ⅰ期愈合,无早期并发症发生。9例患者均获随访,随访时间1～4年,平均2年7个月。末次随访时Harris评分为(87.8±3.9)分,与术前比较差异有统计学意义(t=44.904,P=0.000)。X线片检查示,骨折均于术后8周达临床愈合;随访期间未发现髋臼假体周围透亮带及松动表现。结论初次行THA术前应仔细测量,术中充分显露,精细操作,避免暴力。非骨水泥型髋臼假体直径不应超过髋臼锉直径2 mm;对于骨质疏松患者,宜选用与髋臼锉直径相同的假体并用螺钉固定,或直接采用骨水泥型假体。一旦术中发生髋臼骨折,可根据骨折类型和假体稳定性选用增加螺钉固定或植骨配合多枚螺钉固定。     

金属骨小梁杯在髋臼翻修中的应用及随访

目的探讨设计新颖的组配式骨小梁金属杯在髋臼翻修中的早期效果。方法自2006年4月至2007年2月期间对24例髋臼假体翻修患者使用了骨小梁金属杯,共计25髋,女13例,男11例,平均年龄73．5岁。每个患者术前及术后6个月,1、2、3年,作X线拍片影像学随访,以及进行Harris髋关节（HHS）评分和（UCLA）活动评分。所有患者随访的临床及影像学资料完整。结果术后随访30—40个月（平均36个月）。Harris评分由翻修前的5～57分（平均33．6分）提高到术后的69～95分（平均92．4分）（t=3．943,P〈0．01）,UCLA评分由翻修前的2～5分（平均3．7）提高到术后的7～9分（平均8．6分）（t=3．910,P〈0．01）。影像学随访未见假体移位、下沉等不稳和松动迹象,骨小梁金属杯周围骨质向内长人。结论对于全髋置换手术（THA）中,初次用骨水泥固定的髋臼杯失败的患者,若无骨缺损,翻修时使用骨小梁金属杯可以获得良好的早期效果。     

机器人辅助与常规全髋关节置换术早期疗效及患者满意度的比较

目的探讨机器人辅助全髋关节置换术(total hip arthroplasty, THA)与常规THA术后早期疗效及患者满意度的差异。方法回顾性分析北京大学第三医院骨科在2019年9月至2022年2月因骨关节炎、股骨头坏死等原因接受由同一名术者使用同一品牌假体单侧初次THA手术患者171例。根据手术方式分为机器人辅助组和常规手术组。术后摄骨盆正位及髋关节穿桌侧位X线片, 观察两组患者总失血量、输血率、住院时间、术后并发症、术后髋臼假体前倾角及外展角、髋臼假体位于Lewinnek和Callanan安全区的比例、疼痛视觉模拟评分(visual analogue scale, VAS)、Harris髋关节功能评分、生活质量评分(quality of life, QOL)及患者满意度评分。结果两组患者性别、年龄、身高、体重、体质指数、手术侧别、术前血容量及术前Harris髋关节功能评分的差异均无统计学意义(P>0.05)。2例患者因骨质疏松症导致机器人定位螺钉松动, 术中改为常规手术。常规手术组87例术后随访时间为(19.7±6.8)个月, 机器人辅助组84例为(18.6±5.4)个月,...     

病灶清除植骨保留髋臼假体的翻修术治疗假体周围局灶性骨溶解

目的 探讨病灶清除植骨保留髋臼假体的翻修术治疗全髋关节置换(total hip arthroplasty,THA)术后稳定固定的髋臼假体周围局灶性骨溶解的疗效.方法 2006年3月至2009年3月,THA术后髋臼假体稳定固定的假体周围局灶性骨溶解患者23例(23髋),男13例,女10例;年龄39～54岁,平均46.6岁.23例均为非骨水泥髋臼.初次THA至诊断髋臼假体周围骨溶解的时间为4.6～7.4年,平均5.5年.术前HarTis髋关节评分74分.手术经腹股沟入路,行髂骨内板开窗,清除髋臼骨溶解病灶、同种异体颗粒骨植骨;经后外侧人路更换聚乙烯内衬、股骨头假体,保留髋臼假体.翻修术后1、3、6、12个月及之后每年随访1次,以髋关节Harris评分评价临床疗效,摄X线片、CT扫描观察植骨区愈合、新发骨溶解病灶及假体移位情况.结果 16例获得随访,随访时间8～38个月,平均28个月.末次随访时Harris髋关节评分86～100分,平均93.8分.16例植骨区成骨均良好,12例植骨区完全被周围骨爬行替代,髋臼假体固定好,无髋臼假体松动及移位,无新发髋臼假体周围骨溶解,无异位骨化、脱位、深静脉血栓形成及感染等并发症.结论 清除病灶植骨、保留髋臼假体、更换聚乙烯内衬和股骨头假体的翻修术可有效减少聚乙烯磨损颗粒产生,避免骨溶解病灶进展导致的假体松动,近期随访结果良好.     

生物学固定骨小梁金属杯在髋臼翻修中的应用

[目的] 针对初次固定臼杯松动,其所需髋臼翻修选用何种材料和固定方式为佳,尚无定论.本研究肯定了设计新颖的组配式骨小梁金属杯的早期效果.[方法]自2006年4月-2006年11月期间本院对16例髋臼假体翻修病人使用了骨小梁金属杯,共计16髋,女9人,男7人,平均69.2岁.每个病人术前及术后6个月、1、2年进行Harris髋关节(HHS)评分、UCLA(university of california Los angeles)评分及骨盆前后位片的拍摄.所有病人随访的临床及影像学资料完整.[结果]术后随访18～25个(平均24个月),Harris评分由翻修前的21～54分(平均32.6分)增加到术后的56～90分(平均87.5分),UCLA评分由翻修前的2～5分(平均3.8分)增加到术后的6～9分(平均8.2分),无假体移位及下沉等不稳迹象,骨小梁金属杯周围骨质内向长入.[结论]初次用骨水泥固定人工髋臼杯失败的病例,若无骨缺损,翻修时使用骨小梁金属杯可以获得良好的早期效果.     

全髋关节置换术中内衬高边放置方位的选择

目的探讨全髋关节置换术(THA)中聚乙烯内衬高边放置方位选择应用的经验及可行性。方法分析1 503例行THA中聚乙烯内衬高边放置方位的选择应用情况。术中假体安装完成后测试髋关节极限活动,稳定性良好者将聚乙烯内衬防脱位高边放置在金属髋臼杯后上方;容易发生髋关节后脱位者将聚乙烯内衬高边放置在金属髋臼杯后上方;容易发生髋关节前脱位者将聚乙烯内衬高边放置在金属髋臼杯前上方;金属髋臼杯外翻角偏大者将聚乙烯内衬高边放置在金属髋臼杯正上方。观察术后并发症及患者恢复情况。结果1 503例患者聚乙烯内衬高边具体放置情况:1 407例放置在髋臼杯后上方,20例放置在髋臼杯正后方,25例放置在髋臼杯正上方,51例放置在髋臼杯前上方(其中3例因术后多次发生前脱位,再次手术将内衬高边调整为前上方)。1 253例患者获得随访,时间12～60个月。术后患髋疼痛完全缓解,日常生活基本不受限制,对功能状态满意。无脱位、松动、感染等并发症发生。结论全髋关节置换术中聚乙烯内衬高边多放置在髋臼的后上方,在金属髋臼杯外翻角偏大时也可以将高边放置在髋臼的正上方防止上脱位,在金属髋臼杯前倾角偏大时可以将内衬高边放置在髋臼前上方防止前脱位。     

肢体延长后行全髋关节置换治疗CroweⅣ型髋关节发育不良

目的 探讨骨外固定延长器肢体延长后采用全髋关节置换(total hip arthroplasty,THA)治疗年轻CroweⅣ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)继发骨关节炎的方法与疗效.方法 回顾性分析2007年10月至2012年1月,治疗12例单侧CroweⅣ型DDH继发骨关节炎患者资料,男2例,女10例;年龄18～35岁,平均25.7岁.采取分次手术的方法,初次手术行软组织松解及安装髂股外固定延长器,术后每天延长3～5 mm,待纠正肢体短缩,即股骨头下移至真臼水平后再行THA.THA术中采用生物型假体结合自体股骨头移植重建髋臼.所有手术均无需短缩股骨.结果 初次手术时间(35.2±3.6) min,术后住院时间(13.3±1.6)d.再次手术时间(77.3±12.4) min,术后住院时间(9.2±2.5)d.12例患者均获得随访,随访时间9～48个月,平均(13.6±3.2)个月,肢体不等长由术前(5.6±1.5) cm恢复到术后(0.5±0.2)cm;Harris评分由术前(45.7±2.6)分提高到术后(92.3±3.3)分.12例患者末次随访均获得良好的髋、膝关节功能.术后无一例出现钉道感染、牵引针无菌性松动、髋关节感染、假体松动脱位及深静脉血栓形成等并发症.3例在肢体延长过程中出现小腿一过性神经麻痹,经调整牵引速度后缓解,5例在THA术后出现小腿皮肤麻木,均未行治疗而在术后6周缓解.结论 针对年轻的CroweⅣ型DDH继发骨关节炎患者,可先通过髂股牵引恢复肢体长度,而后再行THA.这种逐步延长的方式既可避免神经损伤,又可显著改善患肢功能,并发症少.     

数字化三维重建技术在髋关节发育不良全髋关节置换术中的应用

目的探讨CT图像数字化三维重建技术在髋关节发育不良(DDH)初次全髋关节置换(THA)中应用的可行性。方法将接受初次THA的23例DDH患者(24髋)纳入研究。术前患者均行三维CT检查,并将数据导入Mimics软件重建髋臼,观察髋臼形态及位置,评估髋臼骨缺损程度,预测臼杯大小、旋转中心位置及是否需要结构性植骨。记录手术时间、术中出血量,评估双下肢长度差,应用Harris评分(HSS)评估髋关节功能。结果手术时间80～150(112. 1±20. 0) min,术中出血量150～1 000(456. 3±231. 9) ml。患者均获得随访,时间13～24(17. 4±3. 1)个月。随访期间未发生髋关节脱位,无假体松动、下沉。末次随访时,HSS评分由术前30～60(46. 7±10. 8)分提高至78～98(89. 6±6. 3)分,差异有统计学意义(P 0. 05);其中优13例,良9例,中1例,优良率22/23;双下肢长度差由术前1. 8～5. 2(3. 2±1. 7) cm减小至0. 3～1. 6(1. 0±0. 4) cm,差异有统计学意义(P 0. 05)。结论对于接受初次THA的DDH患者,术前数字化三维重建有助于精确评估髋臼情况、重建髋臼解剖旋转中心,能够获得满意的临床疗效。     

生物型全髋关节置换术治疗伴有股骨头颈短缩的髋臼内陷症

目的 探讨生物型全髋关节置换术(THA)治疗伴有股骨头颈短缩的髋臼内陷症的手术技巧和疗效.方法 回顾性分析2008年8月至2012年3月采用THA治疗的15例(17髋)伴有股骨头颈短缩畸形的髋臼内陷症患者资料,男6例6髋,女9例11髋;年龄21 ～68岁,平均45.6岁.髋臼内陷症按Dunlop诊断标准分度:轻度1髋,中度11髋,重度5髋.股骨头颈短缩程度:轻度短缩5髋,中度短缩8髋,重度短缩4髋.术后随访行X线片检查观察假体与骨界面骨愈合的情况,采用髋关节Harris评分标准评定患髋功能. 结果 15例患者术后获10 ～ 46个月(平均28.5个月)随访.15例患者17髋术后均立即实现了髋臼及股骨柄的生物性压配.术后3个月X线片显示均获广泛性骨长入,达骨性固定.末次随访时无假体松动和髋臼再次内陷.术后6个月髋关节Harris评分由术前平均(43.1±4.8)分改善至(91.2±5.2)分,末次随访仍维持在(92.5±3.1)分,术后6个月、末次随访时分别与术前比较差异均有统计学意义(P＜0.05). 结论 生物型THA治疗伴有股骨头颈短缩的髋臼内陷症疗效良好,术中操作要点是选择短头试模进行髋关节复位,在保持髋关节张力情况下对髋关节囊及周围软组织挛缩由里向外依次分层松解.     

人工全髋关节置换术中非感染性髋臼骨缺损的治疗策略

目的探讨人工全髋关节置换术在治疗非感染性髋臼骨缺损中的应用。方法 2000年1月至2010年1月间40例非感染性髋臼骨缺损初次行全髋关节置换患者,其中CroweⅢ、Ⅳ型先天性髋关节脱位18例,髋关节感染后融合14例,陈旧性髋臼骨折8例。内移髋关节旋转中心17例,结构性植骨13例,颗粒松质骨打压植骨10例;有14例应用钛网,9例重建钢板,7例加强杯固定。术前术后进行临床评估及X线评估。结果本组手术全部成功,术后无感染发生。本组40例患者随访8～42个月,平均（10.4±2.1）个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善,术前平均Harris评分为（58.4±6.1）分,术后为（88.6±3.1）分;术后平均Harris评分较术前提高明显,两者比较差异有统计学意义（P〈0.05）。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨并辅以颗粒骨,并选用牢固的钉板系统固定,将髋臼重建在真臼位置,并尽量采用非骨水泥型臼杯,通过不同的重建方法可以获得良好的髋关节功能。     

Early total hip arthroplasty for severe displaced acetabular fractures

Objective ： To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures. Methods： Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years（ 1-6 years） and the average period from fracture to operation was 8 days （5-21 day）. The average age of the patients was 53 years （ 26-69 years）. Restdts： At the final follow-up the Harris hip score averaged 82（69-100） points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of lateloosening of the prosthesis. One patient had severe central displacement of the cup. Conclusions： In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.     

Aseptic loosening of 2 rim-fix,hydroxyapatite-coated acetabular cups

Two cases of aseptic loosening in the 11th and 12th year of follow-up of the same acetabular component of a fully hydroxyapatite (HA)-coated total hip arthroplasty are presented. The acetabular cup was a rim-fix type, HA-coated, titanium hemispherical shell secured to the bony acetabulum with titanium screws at the peripheral polyethylene rim. The short-term and midterm results were good with HA-coated total hip arthroplasties, but further studies are needed to investigate whether the >10-year survival of these cups is as good as the survival of cemented ones.     

钽金属大杯重建严重髋臼骨缺损的早期临床疗效观察

目的评估在全髋关节翻修术中应用钽金属Jumbo杯重建严重Gross型髋臼骨缺损的早期临床疗效。 方法回顾性分析了从2012年10月至2016年5月在山西医科大学第二医院关节外科使用钽金属Jumbo杯实施髋关节翻修手术患者17例。男6例,女11例,年龄49～78岁,平均(68± 7)岁。纳入标准：单侧初次翻修(对侧髋关节正常);翻修原因均为无菌性松动;Gross Ⅲ型和Gross Ⅳ型使用Jumbo杯翻修。排除标准：缺血性骨坏死;假体与宿主骨接触面积<30%;任何原因导致的失访。观察其髋关节Harris评分、髋臼外展角变化、髋臼旋转中心(水平及垂直方向位移)变化等情况及并发症,使用SPSS 22.0统计学软件包对手术前后计量指标进行配对t检验。 结果所有患者均获得随访,随访时间(29±14)个月。没有出现假体松动,感染等并发症,只有1例患者于术后5 d后脱位,腰麻下闭合复位,术后皮肤牵引4周,至末次随访未发生脱位。术前Harris评分(32.8±4.8)分,末次随访时(87.1±4.7)分,差异有统计学意义(t＝62.46,P<0.05)。髋臼外展角和位移变化分别小于4°和4 mm,患侧髋臼中心(垂直距离和水平距离),末次随访时和术前相比,差异有统计学意义(t＝10.95,P<0.05;t＝5.53,P<0.05)。末次随访时健患侧髋臼旋转中心位置相比,差异无统计学意义(t＝1.78,P>0.05;t＝0.44,P>0.05)。术后髋臼旋转中心相比术前得到明显改变,与健侧相比差异不明显,基本重建了正常的髋臼旋转中心。 结论钽金属Jumbo杯增加与宿主骨接触面积,假体植入技术简单,减少植骨量,最大限度恢复旋转中心,臼杯骨长入快,可以取得显著的早期临床疗效。     

Locking versus standard screw fixation for acetabular cups: is there a difference?

Introduction

Total hip replacement has been established as a valid treatment option for displaced subcapital fractures. However, insufficient primary fixation may be the reason for early loosening in these osteoporotic patients. Primary fixation of the cup is usually achieved by press-fit fixation that can be enhanced using screws. Locking the screws into their respective cups may seem to improve the primary fixation of the construct, as locked plates proved superior fixation for osteoporotic fractures.

Methods

The study consisted of three groups: in each group, three cups were fixed into blocks of foam bone using press-fit technique. In the first group, no additional screws were used, in the second group two standard screws were inserted, while in the third group two acetabular screws were cemented into the cup to simulate locked screw fixation. Load was applied onto the rim of the acetabular component to cause shearing between the cup and the block. Cup fixation was examined by a loading machine that acquired load versus displacement. The stiffness (load vs. displacement) was calculated.

Results

Screws, either locked or non-locked, enhanced cup fixation by 26 % (p value <0.01). No significant changes were found between the locking and non-locking screws groups.

Discussion

These experimental results indicate that acetabular screws enhance primary cup fixation. This may become significant in conditions where the acetabular bone stock is suboptimal, such as when performing total hip arthroplasty after displaced subcapital fractures. However, there is no superiority for locked screws over standard screw fixation.     

Uncemented cups with and without screw holes in primary THA: a Swedish Hip Arthroplasty Register study with 22,725 hips

Background and purpose — Uncemented cups in total hip arthroplasty (THA) are often augmented with additional screws to enhance their primary stability. We investigated whether there is a difference in the risk for revision between cups with screw holes and cups without screw holes.

Patients and methods — We analyzed the risk for cup revision of uncemented cups registered in the Swedish Hip Arthroplasty Register (SHAR) between 2000 and 2017 with respe ct to the presence of screw holes. Only patients with primary osteoarthritis (OA) were included. 22,725 cups, including 12,354 without screw holes and 10,371 with screw holes, were evaluated. Revision rates at 2 and 10 years after the primary operation were analyzed.

Results — At a median follow-up time of 3.4 years (0–18), 459?cup revisions were reported. The main reasons for cup revision during the whole observation time were infection, 52% of all cup revisions, and dislocation, 26% of all cup revisions. The survival rate with cup revision due to aseptic loosening as endpoint was 99.9% (95% CI 99.8–99.9) at 2 years for both cups with and cups without screw holes, and the survival rates at 10 years were 99.5% (CI 99.3–99.7) and 99.1% (CI 98.6–99.5), respectively. Cups without screw holes showed a decreased risk of revision due to any reason at both 2 years (adjusted hazard ratio [HR] 0.6, CI 0.5–0.8) and 10 years (HR 0.7, CI 0.5–0.9).

Interpretation — We found a very low revision rate for aseptic loosening with modern, uncemented cup designs. Cups with screw holes had an increased risk of revision due to any reason in patients with primary OA     

Reinforcement rings with hook in acetabular reconstruction

Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In the case of major bone loss where less than 50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring in association with a cemented component and allograft bone should be used. Herein we describe the technical details of the use of the Kerboull acetabular reinforcement device and the GAP cup. Both these devices have a hook that has to be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of these devices are their help in restoring the normal hip center of rotation, guiding the reconstruction, and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies.     

Relation between vertical orientation and stability of acetabular component in the dysplastic hip simulated by nonlinear three-dimensional finite element method

In acetabular dysplasia, more vertical orientation of the acetabular component is often used to minimize the superolateral bone grafting. This study was designed to determine the effects of vertical orientation of the cup on the stability and polyethylene wear of the acetabular component in uncemented total hip arthroplasty (THA). Three-dimensional finite element models of the hemipelvis with dysplastic acetabulum were developed. Metal-backed hemispherical cups were placed in the true acetabulum with abduction angles of 35, 45, 55, and 65 degrees. It was found that more vertical orientation of the cup was associated with larger relative motion of the metal shell between the acetabulum and metal shell. Furthermore, tilting and torsional shear stresses in the model of the cup abduction angle of 65 degrees were found to be 1.7 times larger than that in the model with 35 degrees at the bone-metal shell interface. More vertically oriented cups caused larger contact stresses at the articulating surfaces of the polyethylene liners. The results suggest that the abduction angle of the acetabular component significantly influences cup loosening and polyethylene wear in THA.     

Press fit fixation of cementless cups: how much stability do we need indeed?

Introduction: Using screws for a better primary and secondary fixation has been discussed in the literature of the recent years, although the principle of press fit has been explained as the principle of a push-button. The authors wanted to compare their own results in patients using X-rays from the postoperative course to decide if it is really safer to use screws or not. Materials and methods: Two hundred and twenty one consecutive, not selected patients were treated with total hip arthroplasty using a cementless cup type Duraloc. They were followed up over a time of 5 years for radiological changes of the bony acetabulum around the cup (“acetabular zones” according to De Lee and Charnley). One hundred and ten cups were additionally fixed with one to three screws at the upper part in region C1, 101 cups were implanted without the use of screws. Results: Periprosthetic changes visible on the radiographs (immediate postoperative gaps, subsequent sclerosis and radiolucent lines) were assessed according to the time of their appearance. A gap in zone C2 was seen more often immediately after operation within the group without screws (17.8% vs. 7.3%) and disappeared within the following 25 months. Within the group with screws significantly more often a gap was found in zone C1 and C3 compared to the group without screws (7.3% vs. 1.9%). In the group with screws a sclerosis of the bone in zone C1 developed in 32.7% mostly within the first 5 months. It was followed by a radiolucent line in zone C3 in 28.2% mainly within 5–25 months postoperatively and in zone C1 in 20.9% within 16 months. Significantly less seldom were these phenomena seen at the cups without screw fixation. There was no correlation between lateral or medial positioning and deviations from the ideal inclination to the bony changes around the cups. No signs of loosening occurred in either group. Conclusion: Less radiological changes around the cup if no screws were used and no disadvantages within this group led to the conclusion that an additional screw fixation in principle is not necessary in press-fit cups.     

双极人工股骨头与全髋关节置换术在老年患者股骨头缺血性坏死FicatⅢ期的中远期随访比较

目的比较生物型双极人工股骨头置换与全髋置换术治疗老年FicatⅢ期股骨头缺血性坏死患者的中远期疗效。方法对获得随访的61例（64髋）FicatⅢ期股骨头缺血性坏死患者,其中23例（24髋）行生物型双极人工股骨头置换、38例（40髋）行全髋关节置换术对其行回顾分析比较,观察手术前后Harris评分和术后髋部疼痛、影像学变化等情况。结果术后随访5～13年（平均8年）,末次随访Harris评分全髋置换组（88.5±8.9）分,较股骨头置换组（73.5±8.3）分高,差异有统计学意义（t=6.69,P〈0.05）。在疼痛发生率及翻修率上股骨头置换组分别为37.5%（9/24）、29.2%（7/24）,均较全髋置换组10%（4/40）、7.5%（2/40）高,差异有统计学意义（2=5.41、2=5.39,P均〈0.05）。随访X线检查假体位置,股骨头置换组9例出现髋臼磨损,发生率为37.5%;全髋置换组髋臼松动率为2.5%（1/40）,假体柄松动率为5%（2/40）;股骨头置换组5例出现股骨柄松动,发生率为20.8%（5/24）,两组在股骨柄松动发生率上差异无统计学意义（2=2.41,P〉0.05）;在股骨侧骨溶解发生率上股骨头置换组20.8%（5/24）与全髋关节置换组22.5%（9/40）间的差异无统计学意义（2=2.44,P〉0.05）。结论治疗老年FicatⅢ期股骨头缺血性坏死选择双极股骨头置换术应慎重,对于大多数患者,应积极选用生物型全髋置换术。