金属-金属表面髋关节置换与普通全髋关节置换:对年轻及活动量较大患者18个月的随访

背景:第4代金属-金属表面髋关节假体在临床已广泛使用,但是对于其与普通假体的疗效缺乏对照性研究。目的:比较第4代金属-金属表面髋关节假体与普通假体全髋关节置换后早期的临床疗效。方法:纳入初次行全髋关节置换者62例67髋,表髋组30例32髋采用Depuy公司生产的第4代金属-金属髋关节表面置换系统,普通组32例35髋采用施乐辉公司生产的金属-聚乙烯全髋关节置换假体。结果与结论:置换后1.5年随访,表髋组和普通组髋关节Harris评分差异无显著性意义(P>0.05);表髋组髋关节总体活动提高度数高于普通组(P<0.05);与普通组相比,表髋组对股骨偏距及双下肢不等长的影响较小(P<0.05),但手术时间长、手术切口大(P<0.05)。提示金属-金属髋关节表面置换治疗年轻及活动量较大的患者早期随访结果较好,置换后获得了较好的髋关节功能并恢复其生物力学,保留了骨量。但与金属-聚乙烯假体比较,金属-金属髋关节表面置换的操作难度大、手术创伤大、操作时间长。

Metal-metal surface hip replacement versus total hip replacement: 18-month follow-up in young patients and those having many activities

BACKGROUND:The fourth generation of metal-metal surface hip replacement is widely used in clinic,but control researches between metal-metal surface hip replacement and total hip replacement (THR) are rare.OBJECTIVE:To compare the early clinical efficacy effect of the fourth generation of metal-metal surface hip replacement and THR.METHODS:Totally 62 cases of 67 hip prosthesis with first line of THR were divided into table hip group (30 cases with 32 hip prosthesis) and ordinary group (32 cases with 35 hip prosthesis).The fourth generation of metal-metal surface hip replacement which generated from Depuy Company was used for the table hip group.Metal-polyethylene THR prosthesis which generated from Smith & Nephew Company was used for the ordinary group.RESULTS AND CONCLUSION:At 1.5 years follow-up after replacement,there was no significant difference of Harris hip score in the two groups (P>0.05).Hip joint activities of the table hip group were higher than that of the ordinary group (P<0.05).Compared with the ordinary group,unequal length of both lower limbs was decreased (P<0.05),but operating time and incision were lager in the table hip group (P<0.05).It is indicated that metal-metal surface hip replacement for the treatment of large amount of activity and young patients has a better followed-up.After replacement,hip joint function restores the hip biomechanics and bone mass.However,compared with the metal-polyethylene prosthesis,metal-metal surface hip replacement has difficult surgical operation,large surgical trauma and long operation time.