全髋关节置换术治疗成人髋关节发育不良继发骨关节炎五年以上随访研究

目的 评价全髋关节置换术(total hip arthroplasty,THA)在成人髋关节发育不良(develop-mental dysplasia of the hip,DDH)继发骨关节炎患者中的疗效,回顾性分析该类患者THA术后5年以上的临床疗效及其影响因素.方法 对2000年2月至2002年7月在我院采用THA治疗DDH继发骨关节炎的患者55例(69髋)进行术后随访.临床评估以Harris评分为标准.影像学评估根据随访骨盆平片及患髋正、侧位X线片,观察髋臼、股骨假体位置及其周围骨质变化,测量内衬磨损率.假体生存率采用Kaplan-Meier方法进行分析,以任何原因的臼杯、股骨柄翻修或影像学假体明显松动为随访终点.结果 截至随访终点,共45例(57)髋获得5年以上随访,平均随访时间69个月,随访率为81.8%.Harris评分由术前的(46.19±18.01)分提高至末次随访时的(91.78±3.52)分,尚无假体翻修病例.聚乙烯内衬平均磨损率为(0.27±0.14)mm/年.5髋髋臼侧发生骨溶解,8髋股骨侧近端发生骨溶解.Kaplan-Meier分析假体总生存率为1.0(95%可信区间,0.98～1.00).结论 THA治疗DDH继发骨关节炎5年以上随访的影像学表现及临床效果尚可,但存在较高的聚乙烯磨损率及骨溶解发生率,对于年轻、活动量大的DDH患者,THA手术时应选择新型耐摩擦界面假体.DDH患者的定期随访尤为重要,可甲期发现骨溶解,及时给予相应的治疗.

More than five-year results of total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip

Objective To evaluate more than five-year clinical and radiographic outcomes associated with total hip arthroplasty (THA) in a consecutive series of patients with osteoarthritis secondary to developmental dysplasia of the hip. Methods From February 2000 to July 2002, 55 patients (69 hips) underwent THA in our hospital were involved in this study. Clinical outcomes were evaluated according to Harris score. Components migration, periprosthetic bone changes, the polyethylene wear rate were measured radiologically. Kaplan-Meier analysis was performed to evaluate the survival rate of the acetabular and femoral component. End point was obvious radiological loosening or revision either or both of the acetabular and femoral components for any reason. Results Forty-five patients (57 hips) were fidlowed up at least 5 years. The average preoperative Harris hip score was (46.19±18.01) points, which improved to (91.78±3.52) points at final follow-up. The mean polyethylene liner wear rate was (0.27±0.14) mm/year. There are 5 pelvic osteolyses and 8 proximal femoral osteolyses. Using loosening or revision as the end point for failure, the survival rate of both components was 1.0 (95% confidence interval, 0.98-1.00). Conclusion THA in the treatment of osteoarthritis secondary to developmental dysplasia of the hip has a satisfactory clinical and radiographic outcomes at a minimum five-year follow-up. Because of obvious polyethylene liner wear rate and high incidence of osteolysis, further follow-up for the component is very important.