金属对金属与金属对聚乙烯假体全髋关节置换术近期疗效比较研究

目的：比较大直径金属对金属（MOM）与金属对聚乙烯（MOP）假体全髋关节置换（THA）的近期疗效。方法回顾性分析2009年1月至2010年1月在苏州大学附属第一医院骨科行THA手术的44例（44髋）患者的临床资料，其中MOM组（22例22髋）采用大直径MOM承重界面假体，MOP组（22例22髋）采用MOP承重界面假体。对两组术中髋关节活动度，术后下床活动时间、Harris评分、影像学表现及并发症进行比较。结果两组术中髋关节屈曲、内收、外展、屈髋内旋、屈髋外旋活动度比较，差异有统计学意义（P＜0.05）。全部患者获得随访，MOM组术后平均随访30个月（18～37个月），MOP组术后平均随访25个月（16～35个月）。MOM组和MOP组术后下床活动时间分别为（3±1）d和（7±2）d，两组比较，差异有统计学意义（P＜0.05）。术前，术后l、3、6、12个月及末次随访时，MOM组和MOP组Harris评分分别为（37.8±4.8）、（85.6±3.2）、（89.4±4.1）、（94.5±2.3）、（94.7±3.1）、（93.8±3.6）分和（38.5±5.5）、（80.2±4.4）、（83.6±2.9）、（90.8±2.7）、（91.6±3.6）、（89.6±6.3）分，术后各时相点与术前比较，差异有统计学意义（P＜0.05）；两组术后不同时相点比较，MOM组均高于MOP组（P ＜0.05）。术后12个月MOM组和MOP组髋关节总活动范围分别为（236±9）°和（203±10）°，与术前的（119±14）°和（112±15）°比较，差异有统计学意义（P＜0.05）；术后12个月MOM组髋关节活动度优于MOP组（P ＜0.05）。X线片检查示MOM组22髋股骨假体位于中立位，无内外翻，无股骨假体下沉；MOP组1髋轻度内翻位，术后6个月1髋出现＜1.5 mm的下沉，至末次随访股骨假体位置无明显改变。至末次随访，两组患者均未出现脱位、感染、神经损伤、深静脉血栓、假体无菌性松动、髋臼及股骨骨折或骨溶解等并发症。结论与MOP比较，采用大直径MOM行THA能够增加髋关节活动度，更为有效地恢复髋关节功能，术后可早期下床活动，临床效果明显。

Comparison of short-term efficacy of total hip arthroplasty using prosthesis with metal-on-metal versus metal-on-polyethylene bearing surfaces

Objective To compare short-term results of total hip arthroplasty （THA） using prosthesis with metal-on-metal （MOM） versus metal-on-polyethylene （MOP） bearing surfaces. Methods A total of 44 patients （44 hips） underwent THA from January 2009 to January 2010 in the First Affiliated Hospital of Soochow University. These patients were divided two group, those who underwent THA using large diameter MOM prosthesis （MOM group） and those who underwent THA using MOP prosthesis （MOP group）. Intraoperative range of motion （ROM） of hip joint, times of postoperative ambulation, postoperative Harris scores, radiological results and complications in two groups were compared. Results Intraoperative ROM of hip joint in MOM group was larger than that in MOP group. All patients had been followed up, with the average time of 30 months （18-37 months） in MOM group, and 25 months （16-35 months） in MOP group. The time of postoperative ambulation in MOM and MOP group were （3 ± 1） d and （7 ± 2） d respectively, there had statistical difference between two groups （P 〈0.05）. At preoperation, 1, 3, 6 and 12 months postoperatively, as well as the last follow-up, Harris score in MOM group was 37.8 ± 4.8, 85.6 ± 3.2, 89.4 ± 4.1, 94.5 ± 2.3, 94.7 ± 3.1, 93.8 ± 3.6 respectively, while 38.5 ± 5.5, 80.2 ± 4.4, 83.6 ± 2.9, 90.8 ± 2.7, 91.6 ± 3.6, 89.6 ± 6.3 in MOP group. There was statistically significant in postoperative Harris score between two groups （P 〈0.05）. At 12 months after the surgery, total ROM of hip joint was （236 ± 9）° and （203 ± 10）° in MOM and MOP group, both were higher than preoperative （119 ± 14）° and （112 ± 15）° （P 〈0.05）; and at 12 months postoperatively, that in MOM group was better than that in MOP group （P〈0.05）. Radiographic results showed that 22 femoral prosthesis were in neutral position in MOM group without varus, valgus deformation or implant subsidence; However, in MOP group, one hip was in mild varus, and one hip had prosthesis subsidence less than 1.5 mm at 6 months after the operation. At the final follow-up, there was no significant change in prosthesis location. At the final follow-up, no patients were observed dislocation, infection, nerve injury, deep vein thrombosis, aseptic loosening, osteolysis or fractures of acetabulum or femur. Conclusion Short-term results of THA with MOM may be better than THA with MOP, especially for the aspects of ROM of hip joint, hip joint function and early ambulation.