骨水泥和非骨水泥型人工股骨双动头置换的临床疗效分析

[目的]比较骨水泥型与非骨水泥型人工股骨双动头治疗老年移位型股骨颈骨折的疗效。[方法]本科2005年1月～2007年5月收治的股骨颈骨折(GardenⅢ、Ⅳ型)患者100例,其中男31例,女69例,年龄70～98岁,平均78.3岁。左髋52例,右髋48例。手术均为同一术者操作,全部患者随机分为两组,各50例,采用骨水泥和非骨水泥股骨假体治疗。术后随访5年。主要观察指标:手术时间,术中失血,并发症,视觉模拟评分,髋关节Harris评分、病死率和假体翻修率。组间比较采用两样本t检验,P<0.05为差异有显著性意义。[结果]骨水泥组手术时间平均57min,非骨水泥组平均47min,术中失血骨水泥组平均238ml,非水泥组230ml。视觉模拟评分及Harris评分两组无明显差异。手术并发症:非水泥组(28例)多于水泥组(21例)。两组均未见明显髋臼磨损。翻修非水泥组(2例)多于水泥组(1例)。随访各时间点的死亡率两组无明显差异。[结论]人工股骨双动头治疗老年股骨颈移位骨折,在手术时间上,非水泥组占优,并发症方面,骨水泥组占优,术中失血,视觉模拟评分,髋关节Harris评分,髋臼磨损率,病死率和假体翻修率方面两组没有显著差别。     

非骨水泥假体在髋关节翻修术中的应用

目的：分析人工关节置换术后翻修的原因。探讨非骨水泥假体在髋关节翻修术中的应用效果。方法：人工髋关节置换术后患者36例42侧髋关节。其中男26例。女10例，年龄35-78岁。平均50岁。人工关节置换术后3个月-16年，平均6年3个月。翻修的原因；髋关节疼痛不伴假体明显松动11例11髋，感染2髋，无菌性松动27髋，假体柄位置异常2例。42个髋臼中无髋臼骨缺损者10髋，GustilloⅠ，Ⅱ型髋臼松动14髋，Ⅲ型髋臼松动10髋，对上述患者直接用纯钛螺旋臼成型或髋臼底加用颗粒植骨，Ⅳ型松动骨缺损8髋。采用颗粒植骨，钛网重建髋臼，骨水泥髋臼假体成型。40侧股骨进行了翻修术。其中假体无松动12髋。GustilloⅠ型，Ⅱ型，Ⅲ型及Ⅳ型假体柄松动分别为6，8，13和1个髋关节，取出假体柄后视情况植入非骨水泥普通假体柄或加长柄，视骨缺损情况进行假体周围植骨，必要时捆绑带固定。结果：髋臼侧进行了钛网重建植骨的8例患者术后3d可以下地非负重柱拐行走，其余患翥 均可于术后3d下地负重行功能练习，术后随访6-66（平均22）个月。无假体自欺欺人多位下沉等不稳迹象，无需要再重新翻修的病例。Harris评分由翻修前的5-54分（平均32.6分）增加到术后的56-98分（平均88.1分）。随访X线片显示部分患者骨质改建，密度增加，未发现假体周围有新出现透亮带的患者。结论：最常见翻修的原因为无菌性松动。其次为股骨头或双动头置换术后金属与髋臼之间摩擦产生的疼痛，采用非骨水泥型假体对髋关节进行翻修术后中，近期可取得良好的手术效果。远期效果有待随访。     

骨水泥与非骨水泥型假体全髋关节置换术后疗效比较的系统评价

[目的]系统评价骨水泥型与非骨水泥型假体全髋关节置换术后疗效。[方法]计算机检索(时间为1990~2013年12月)MEDLINE、EMBASE、Cochrane CENTRAL(Fourth Quarter 2013)、ScienceDirect、OVID、SpringerLink数据库。制定纳入和排除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量。利用RevMan5.1.1(下载于Cochrane Library)进行Meta分析。[结果]经过筛选,10篇研究符合纳入标准,共1015例,其中骨水泥组496例,非骨水泥组519例。Meta分析结果显示:骨水泥组与非骨水泥组比较,前者术后5年内疼痛改善率优于后者,差异存在统计学意义(95%CI 1.62[0.41,2.83],P=0.009);术后翻修率、Harris评分、并发症和死亡率等方面两种假体组间差异无统计学意义(P值分别为0.17,0.68,0.53,0.94)。[结论]骨水泥型与非骨水泥型假体全髋关节置换在治疗股骨颈骨折及髋关节疾病中均取得了良好的疗效。骨水泥与非骨水泥型假体总体生存率及翻修率无明显差异,骨水泥型假体早期患者疼痛改善方面优于非骨水泥型假体,两组术后患者髋关节功能均达到满意效果,二者术后并发症及死亡率基本相同。     

非骨水泥型全髋关节置换术治疗酒精性股骨头坏死

[目的]研究非骨水泥型全髋关节置换术治疗酒精性股骨头坏死的中期疗效.[方法]1997年3月～2002年6月,采用非骨水泥型全髋关节置换术治疗酒精性股骨头坏死41例(47髋),进行至少5年的随访、中期临床评估和影像学评估.临床评估以Harris评分为标准.影像学根据骨盆正位和髋关节侧位X线片,观察髋臼、股骨假体的位置以及周围骨质的改变.假体的生存率采用Kaplan-Meier分析,分别以股骨、髋臼假体的无菌性松动和任何原因所致的翻修为终点.[结果]得到至少5年随访的41例(47髋),术前Harris评分为42.4±6.4(24～49)分,最后1次随访评分为91.8±4.4(74～100)分.至最后1次随访时无1例翻修或表现为影像学无菌性松动,2髋出现骨盆局灶性骨溶解,6髋出现股骨局灶性骨溶解.Kaplan-Meier分析假体的生存率1.0(95%可信区间,0.98～1.0).[结论]非骨水泥型全髋关节置换术可为晚期酒精性股骨头坏死患者提供良好的中期临床效果.由于假体磨损、假体周围骨溶解等潜在因素,长期效果需要进一步随访.     

非骨水泥与骨水泥长柄翻修股骨假体周围骨折比较

[目的]比较股骨假体周围骨折(periprosthetic femoral fracture, PFF)翻修术使用Zweymull?er生物型长柄与传统骨水泥假体的临床效果。[方法]回顾性分析2017年6月～2019年6月本院翻修置换术治疗的PFF患者60例,其中,32例接受Zweymüller生物型长柄股骨假体翻修,28例接受骨水泥型长柄股骨假体翻修。比较两组围手术期、随访与影像资料。[结果]非水泥组手术时间、术中出血量、术后下地行走时间、住院时间均显著优于骨水泥组(P0.05)。非水泥组完全负重活动时间显著早于骨水泥组(P0.05)。与术后1个月相比,末次随访时,两组患者VAS评分显著下降(P0.05),而Harris评分和髋伸屈ROM显著增加(P0.05)。相应时间点,非水泥组VAS评分、Harris评分和髋伸屈ROM均显著优于骨水泥组(P0.05)。影像方面,末次随访时,非水泥组股骨前倾角、颈干角和股骨前弓角均优于骨水泥组(P0.05)。非水泥组骨折愈合时间显著早于骨水泥组(P0.05)。[结论]对于股骨假体周围骨折的翻修置换术,采用非水泥假体的临床结果优于骨水泥型假体。     

非骨水泥型假体人工股骨头置换术治疗老年股骨颈骨折

目的探讨非骨水泥型假体人工股骨头置换术治疗老年股骨颈骨折的疗效与注意事项。方法回顾性分析自2016-01—2019-12采用非骨水泥型假体人工股骨头置换术治疗的71例老年股骨颈骨折,末次随访时采用髋关节功能Harris评分评定疗效,观察并发症发生情况。结果 71例均获得随访,随访时间平均18(12～36)个月。所有患者均在术后2周内下床不负重行走,无髋关节脱位倾向。术后4周所有患者步态恢复正常。末次随访时髋关节功能Harris评分为(86.36±9.67)分,较术前明显改善。术后3例出现肺部感染,对症治疗后痊愈;2例发生股骨假体远端股骨干骨折,采用切开复位内固定手术治疗。结论非骨水泥型假体人工股骨头置换术治疗老年股骨颈骨折手术时间缩短,术中出血量减少,可避免出现骨水泥植入综合征,降低手术风险。非骨水泥型假体置入后依靠骨组织长入使骨与假体表面形成紧密的生物固定,进而实现良好的骨传导,但是需要注意防范早期假体松动与假体周围骨折。     

非骨水泥假体髋关节翻修术随访报告

[目的]探讨非骨水泥假体在髋关节翻修术中的临床效果.[方法]对本科1997年11月～2007年8月行非骨水泥人工全髋关节翻修术36例(41髋)患者进行了随访,其中29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄.随访X线片上的假体变化情况,分析AAOS、Paprosky骨缺损分类对翻修时假体选择的指导作用,对髋关节行Harris功能评定并分析假体生存率.[结果]24例28髋获得随访,平均随访4.6年(1～11年),患者平均Harris评分由术前的38分(11～76分)增加到末次随访时的88分(60～99分).21髋(75%)假体获得良好稳定性;1髋股骨1区形成2 mm宽的透亮线,临床检查无松动迹象;4髋发生骨溶解并假体移位(股骨1髋,髋臼3髋)而需要再翻修,失败率为12.5 %;8髋发生异位骨化;聚乙烯衬垫年平均磨损量为0.08 mm(0～0.25 mm),磨损率仅与外展角变化存在相关.AAOS分类术前、术中的一致性较Parprosky分类高.分别以任何原因进行了再翻修和影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析计算假体4.6年存活率分别为89%、81%.[结论]非骨水泥型假体可用于初次髋关节置换术失败的翻修.术中对骨缺损进行细致的评估并选择合适的假体固定,能达到令人较满意的临床效果.     

解剖型非骨水泥全髋人工关节置换术近中期疗效研究

目的探讨解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病的近中期临床疗效。方法2001年1月~2005年6月,采用Ribbed解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病34例(38髋)。年龄29~55岁,平均42.7岁。病程3~18年,平均5.2年。其中股骨颈骨折7例7髋,髋臼骨折后创伤性关节炎5例5髋,股骨头坏死15例16髋,强直性脊柱炎7例10髋。术后获随访的21例患者术前Harris评分25~57分,平均38.6分。结果21例(23髋)获随访8~61个月,平均35个月。术后Harris评分76~98分,平均92.3分,与术前比较差异有统计学意义(P<0.05);术后髋关节功能优良率达93.5%。其中4例出现轻微大腿疼痛,经休息或服用非甾体类止痛药物后缓解。随访时X线片未见假体松动和下沉,呈骨长入性稳定。结论应用Ribbed解剖型非骨水泥全髋人工关节置换术治疗髋关节疾病,近中期效果满意。     

应用抗菌素骨水泥旷置分期翻修治疗人工髋关节置换术后感染

目的 评估应用抗菌素骨水泥旷置分期翻修（TSEA）治疗髋关节置换术后感染的疗效。方法 1998年1月～2005年1月，采用TSEA治疗8例髋关节置换术后感染患者，所有患者均行细菌培养检查，一期清创假体取出滴注2例，清创后假体取出加PR-40抗菌素骨水泥支架旷置6例；二期翻修采用非骨水泥假体3例，骨水泥型假体3例，混合髋2例；手术前后髋关节功能通过Harris评分评估。结果 4例细菌培养为金黄色葡萄球菌，3例为混合感染，1例细菌培养阴性。一期处理后所有伤口均愈合，一、二期平均间隔5．5个月。术后平均3年4个月随访时髋关节Harris评分由术前31．1分提高至62．9分。结论 TSEA是治疗髋关节置换术后感染非常有效的方法，其中碘氟浸泡髓腔和抗菌素骨水泥旷置是主要手段。骨水泥复合万古霉素对耐受甲氧西林金黄色球菌人工关节感染治疗有效。     

Titan型骨水泥假体柄中长期随访结果

目的观察Titan型骨水泥假体柄在初次全髋置换中的中远期结果。方法所有55例患者均进行术前术后以及临床随访功能评定,随访X线片了解假体情况,采用Harris评分系统进行临床功能评价。结果因其他疾病死亡5例,失访10例,40例得到随访。1名患者因髋臼侧松动行翻修后假体不匹配行股骨柄翻修术,股骨柄的生存率为97.5%。结论 Titan骨水泥假体因其特殊的设计取得了良好的临床效果,正确使用骨水泥技术,骨水泥固定股骨柄可以取得良好的中长期效果。     

Conversion total hip arthroplasty: Primary or revision total hip arthroplasty

Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.     

微创全髋人工关节置换术及全髋关节表面置换术

髋关节成形术是应用一种手术的方法使一个强直或畸形、疼痛的髋关节转变为一个灵活的、无痛的、比较符合生物力学解剖结构和恢复接近较正常功能的髋关节。在开展髋关节成形术的早期，往往于修整了关节面以后，在股骨头与髋臼之间置入某种隔置物（如阔筋膜或皮肤等），以防止手术后两关节面之间重新粘连融合，但效果并不明显。     

同期与分期双侧全髋置换术临床比较分析

目的 比较同期与分期双侧全髋置换术围手术期安全性及相关临床指标.方法 同期双侧全髋置换术(THA Ⅰ组)74例(148髋),分期双侧全髋置换术(THA Ⅱ组)54例(108髋),比较两组术前合并症、术后并发症、手术时间、总失血量、输血量、手术前后Harris评分、血红蛋白、血细胞比容、住院天数、总费用等临床指标.结果 两组性别、年龄、术前合并症、手术前后Harris评分、血红蛋白、血细胞比容比较差异均无显著性(P＞0.05).THA Ⅰ组平均手术时间(135.7±33.0)min、总失血量(1 378.6±571.7)ml、输血量(575.8±582.6)ml,THAⅡ组平均手术时间(161±46.1)min、总失血量(1 589.5±628.0)ml、输血量(544.6±582.6)ml,两组差异无显著性(P＞0.05).THA Ⅰ组平均住院天数(15.7±4.1)d、总费用(69 603±27 054.7)元,THAⅡ组平均住院天数(29.2±10.8)d、总费用(107 169±51 697.1)元,两组差异有显著性(P＜0.01).THA Ⅰ组冲经系统并发症(P=0.017)、心血管系统并发症(P=0.012)发生率比THA Ⅱ组高,差异具有显著性;其他系统并发症差异无显著性(P＞0.05).结论 同期双侧髋关节置换术是安全有效的手术方案,并且能够降低住院天数、减少住院费用.     

混合型全髋关节置换术

全髋关节置换术的固定方式分两类：骨水泥固定和非骨水泥固定。骨水泥固定是指用骨水泥将假体固定于宿主骨上；非骨水泥固定是指以压配方式将假体直接固定于宿主骨，继而通过骨长入或骨长上来固定假体。所谓的混合型全髋关节置换术（混合髋），是指髋臼和股骨假体一侧以骨水泥固定、一侧以非骨水泥固定的全髋关节置换术。本文所说的混合型全髋关节置换术特指髋臼侧采用非骨水泥固定，股骨侧采用骨水泥固定的全髋关节置换术。     

Conservative total hip arthroplasty

Surface replacement arthroplasty of the hip is a relatively new procedure by orthopedic standards. The test of time is not yet far enough along to allow sound conclusions to be made, but the early results have been encouraging. Most of our failures occurred early in our experience, and our resulting have been steadily improving as our knowledge grows. Significant improvements have been made in surgical technique and prosthetic design. Refinements continue, and we are confident that surface replacement will withstand the test of time and prove to be a useful procedure, especially in younger patients suffering from severe cox arthrosis.     

Custom total hip arthroplasty

Custom total hip arthroplasty (THA) has been advocated as a primary operation to achieve optimal proximal fit and fill in THA. Because of the increased cost of the implant, it must be proved that survivorship of the custom component is improved compared with a well-cemented or cementless off-the-shelf femoral prosthesis. A series of 64 primary and revision femoral component custom titanium uncemented THAs were reviewed. In the primary custom group 90.9%, and in the revision group 80%, had good to excellent results using the Harris hip scoring system at a mean follow-up period of 6.5 years. The age range was 32 to 74 years (mean, 53 years). Thigh pain was present in 17% of the patients in this series. Significant osteolysis occurred in 4.7% of the cases. The average time to failure for the four primary custom THAs was 4.1 years, and for the four revision custom THAs, 2.4 years. Despite excellent proximal fit and fill, these short-term results have not resulted in improved success rates compared with a well-cemented or cementless off-the-shelf femoral component when performing THA.     

Hybrid total hip arthroplasty

One hundred twenty-six primary total hip arthroplasties composed of a hybrid cemented femoral component and a cementless acetabular component were followed for a minimum of two years (mean, 42 months). The average patient age was 63 years. The most common diagnosis was osteoarthritis (85 hips), although 13 of the cases were severe or total congenital dislocations. Overall, the results were excellent. The mean Harris hip score was 93. Postoperative pain was rated as none or slight in 94% of the cases. No patient had moderate or severe pain. No femoral or acetabular components were revised. Roentgenographically no femoral component was definitely or probably loose. One acetabular reconstruction component had migrated. The authors conclude that the selective use of cemented and cementless fixation by anatomic site in this hybrid form of hip arthroplasty provided excellent results for five and one-half years.     

Revision total hip arthroplasty

Two hundred and ten hips in 206 patients who had an initial total hip arthroplasty performed at the Mayo Clinic between 1969 and 1978 required revision of the arthroplasty at the Mayo Clinic for reasons other than infection. One hundred and sixty-two of the patients (166 hips) were followed both clinically and roentgenographically for two years or more. One hundred and forty-five (90 per cent) reported that they had improvement after the surgical revision. Complications that occurred with revision included deep sepsis, superficial would infection, dislocation, intraoperative femoral fracture, and postoperative femoral fracture. Roentgenographic analysis showed probable loosening in thirty-three acetabular components (20.1 per cent) and seventy-two femoral components (44 per cent). Symptomatic loosening (moderate to severe pain and probable roentgenographic loosening) was seen in thirty-five patients. Eight patients required a second revision for this reason, and seven others required a second revision for other reasons. Modified Harris hip scores, calculated for 108 hips, showed a good or excellent result in sixty-seven hips (62 per cent), a fair result in twelve (11 per cent), and a poor result in twenty-nine (27 per cent). Using a new Mayo Clinic hip score that incorporates roentgenographic data (which will be described) in the evaluation of 165 revised hips, there was a good or excellent result in eighty-five (52 per cent), a fair result in thirty-two (19 per cent), and a poor result in forty-eight hips (29 per cent). Although 90 per cent of the patients thought that their condition had improved, the high incidence of roentgenographic signs of probable loosening of a component is of serious concern.