陶瓷对陶瓷的全髋关节置换

背景：目前陶瓷制造工艺方面仍在不断改进,陶瓷对陶瓷摩擦界面的假体成为关节外科领域关注的焦点,并取得了良好的临床疗效,然而随着陶瓷对陶瓷摩擦界面假体的广泛应用,出现了假体碎裂和高调摩擦音等一系列问题。目的：探讨陶瓷对陶瓷全髋关节置换的初期临床疗效。方法：对常熟市第一人民医院2006年1月至2010年6月间小于55岁行陶瓷对陶瓷全髋关节置换的50例患者进行随访,其中男19例( 20髋),女31例(33髋),平均年龄45岁,随访时间平均20(12-42)个月。置换前后均采用Harris评分进行疗效评估,影像学随访包括髋臼假体外展角和前倾角,假体松动采用Kawamura及Engh标准,骨溶解采用Engh标准,异位骨化依据Brooker法评价。结果与结论：置换前Harris评分为(48.10±26.33)分,置换后为(91.10±19.78)分。置换后随访无患者有关节异响的主诉,未见假体松动,未发生假体周围感染,无可观察到的磨损和骨溶解,无明显异位骨化。其中,1例因髋臼陶瓷内衬碎裂翻修。可见陶瓷对陶瓷全髋关节置换对于年轻的骨质量较好的患者短期疗效显著,长期疗效有待于进一步随访。

Ceramic-on-ceramic total hip arthroplasty

BACKGROUND:At present, the ceramic manufacturing process has been improved constantly, and the ceramic-on-ceramic friction interface prosthesis has become the focus in the field of joint surgery and has achieved good clinical effects. However, with the wide application of ceramic-on-ceramic friction interface prosthesis, the prosthesis fragmentation and high-profile fricative appear. OBJECTIVE:To discuss the preliminarily clinical effects of ceramic-on-ceramic total hip arthroplasty.METHODS:Fifty patients less than 55 years old treated with ceramic-on-ceramic total hip arthroplasty between February 2006 and June 2010 in the First People’s Hospital of Changshu were enrolled for follow-up visit. There were 19 male patients (20 hips) and 31 female patients (33 hips). The average age of the patients was 45 years. All the patients were followed-up for an average of 20 months (ranged 12-42 months). The clinical effects were evaluated with Harris score preoperatively and postoperatively. Radiographic follow-up included the outreach angle and anteversion angle. The prosthesis loosening was evaluated with Kawamura and Engh standard. Osteslytic lesions were defined according to the Engh standard, and heterotopic ossification was defined according the system of Brooker.RESULTS AND CONCLUSION:The average Harris score improved from (48.10±26.33) points preoperatively to (91.10±19.78) points postoperatively. No patient presented joint abnormal sound, prosthesis loosening, periprosthetic infection, observed wear, osteolysis or heterotopic ossification. One patient had renovation due to acetabular ceramic liner fragmentation. It showed that ceramic-on-ceramic total hip arthroplasty offers a promising choice for young patients with better bone quality, and the long-term effect needs to be further observed.