生物型陶瓷人工双极股骨头假体的5年临床和放射学影像随访分析

目的 评估应用生物型陶瓷人工双极股骨头假体置换治疗老年新鲜股骨颈骨折的5年临床和放射学影像随访疗效.方法 回顾性分析2005年4月至2007年4月,87例接受生物型陶瓷人工双极股骨头置换治疗的老年股骨颈骨折患者,男39例,女48例;年龄72～96岁,平均（83.4±4.12）岁.股骨颈骨折的分型按Garden分型：Ⅲ型32例,Ⅳ型55例.术前均经常规双能X线吸收测量法（DXA）检测脊柱及髋部骨密度（BMD）筛选,全部采用Biomet生物型Bi-Metric系列股骨假体和陶瓷双极股骨头假体.患者分别在手术后1.5、3、6、12个月及之后每年随访一次,根据临床髋关节活动度和Harris评价标准,放射学影像根据AAOS评价指标：髋臼磨损情况,陶瓷组件碎裂情况,假体周围骨溶解及溶骨性病变情况,股骨近端骨生长情况,股骨距重塑,股骨假体远端底座形成情况等.结果 实际83例患者完成终末随访,随访时间61～82个月,平均（72.4±6.57）个月.髋关节活动范围在终末随访时为：屈曲平均（83.5 °± 9.14°）,后伸平均（25.2°±5.62°）,外展平均（41.5°±5.21°）.Harris评分从术前平均（11.5±4.0）分,提高到终末随访时平均（89.1±2.1）分,手术前后有统计学差异（t=27.18,P〈0.01）;其中优31例,良40例,可10例,差2例,优良率为85.54%（71/83）.5例（6.02%）患者出现腹股沟区和大腿前侧疼痛,2例（2.41%）患者在手术后3～5年间由于股骨假体出现松动而进行股骨假体翻修.放射影像学随访观察无髋臼严重磨损,无陶瓷组件碎裂,无股骨假体周围骨溶解,无股骨假体松动,股骨近端骨生长情况良好,有24例（28.92%）患者发生股骨假体远端轻度底座形成.结论 应用生物型陶瓷人工双极股骨头假体置换治疗老年新鲜股骨颈骨折获得较好的5年临床和放射学影像随访效果.

Five-year clinical and radiographic follow-up of hip hemiarthroplasty with cementless porous-coated anatomic femoral component and ceramic bipolar femoral head prosthesis

Objective To evaluate the five-year clinical and radiographic outcomes of the hip arthroplasty with the cementless porous-coated anatomic femoral component and the ceramic bipolar femoral head prosthesis. Methods 87 hips with femoral neck fractures were treated by hip arthroplasty from April 2005 to April 2007, including 39 males and 48 females with an average age of （ 83.4 ± 4.12 ） years （range, 72-96 years）. The evaluations on preoperative BMD were carried out by conventional DXA detection at the spine and hip area. According to the Garden classification, there were 32 cases of type Ⅲ, and 55 cases of type IV. All the cases were treated by Biomet＇s Bi-Metric cementless porous-coated anatomic femoral component and the ceramic bipolar femoral head prosthesis. According to the ranges of hip movement, Harris hip score and radiographic evaluation based on the criteria of the AAOS. the standard clinical evaluations were used in this prospective study. The follow-up was carried out at 1.5, 3, 6, 12 months and yearly after the surgery. The radiographic assessment included the evaluation of the acetabular wear, the fragmentation of the ceramic components, the loosening of the femoral prosthesis, the calcar remodeling and the pedestal formation. Results 83 cases were followed up with an average of （72.4±6. 57） months （range, 61-82 months）. The average ranges of the hip movement at thefinal follow-up were as follows： flexion （83.5° ±9. 14°）, extension （25.2°± 5.62°）, and abduction （41.5°±5.21°）. The average Harris hip score improved from （ 11.5 ± 4. 0） points preoperatively to （89. 1±2. 1） points at the last follow-up, including excellent in 31 cases, good in 40 cases, fair in 10 cases and bad in two cases. The statistical analysis of the paired t-test results showed significant difference （ t = 27.18, P 〈 0. 01 ）. Five hips （6.02%） had pain in the anterior part of the thigh and groin area. Two hips （2.41%） required revision of the femoral component because of aseptic loosening in 3-5 years post-operation. The radiographic assessment revealed that no aeetabular wear and fragmentation of the ceramic components, no loosening of the femoral prosthesis, and no completely radiolueent lines were identified except around the stems that had loosened. No osteolytic lesions of the femur or progressive pelvic osteolysis was identified. 24 femoral components （28.92%） had slightly pedestal formation. Conclusion The anatomically designed femoral implant and the ceramic bipolar prosthesis used to treat for the aged patients with femoral neck fractures can provide good clinical results, with low incidence of thigh pain and the component loosening.