四代陶瓷对陶瓷全髋关节置换术治疗晚期股骨头坏死

目的探讨应用四代陶对陶Pinnacle全髋关节置换术治疗晚期股骨头坏死的手术方法及疗效。方法自2005年1月～2010年3月，56例患者（88髋）接受了Pinnacle关节置换手术；年龄36．3—68．1岁，平均49．2岁。病史7～21年，根据ARCO分期：所有88髋均为股骨头坏死Ⅳ期，其中激素性32例55髋，酒精性21例30髋，创伤性3例3髋。术前Harris评分为31～63分，平均47．5分，所有髋给予全髋关节置换术，正确放置假体位置，术后定期复查，给予Harris评分。结果随访时间为2—7年（平均6．2年），Harris评分由术前47．5恢复到术后97．2。1例髋臼假体术后1年时发生松动，考虑手术技术导致，给予大号髋臼假体翻修，术后随访4年，未见不良结果出现。1例髋关节术后2d内发生关节脱位，给予麻醉下复位下肢皮牵引2周，无脱位再次发生。其他假体均位置良好，尚未见其他并发症发生。结论全髋关节置换术治疗伴有严重关节炎的晚期股骨头坏死效果好，四代陶对陶（Pinnacle）关节由于其股骨头假体较大，患者术后活动度大功能恢复满意，但需要充分的术前准备及良好的手术技巧，避免并发症的出现。

Treatment of advanced osteonecrosis of femoral head with Pinnacle total hip arthroplasty

Objective To explore the operative method and clinical effects of Pinnacle total hip arthroplasty （THA） in the treatment for the advanced osteonecrosis of the femoral head combined with severe arthritis. Methods There were 56 patients （88 hips） accepted THA from January 2005 to March 2010, with an average age of 49.2 years （range, 36. 3 to 68. 1 years,）. According to the etiology, 32 cases （55 hips） were steroid induced type, 21 cases （30 hips） were alcohol induced type, and the other three cases （three hips ） were traumatic type. According to ARCO staging, all the hips were stage Ⅳ combined with severe arthritis. The preoperative Harris scores was 47.5 in average （ from 31 to 63 ）. All the involved hip accepted THA, the osteophytes were cleared and the soft tissues were released during the operation. The examination and Harris scoring were performed regularly after surgery. Results The mean follow-up time was 6.2 years （2 -7 years ）, and all the patients were followed up. Harris scores significantly improved compared with that of preoperation （from 47.5 to 97.2 ）. One prosthesis of acetabular loosed after one years, it was treated by larger size prosthesis, and no loosening occurred again during the next four years. One hip dislocation occurred two days after operation, it was treated with skin traction for two weeks, and no dislocation occurred again. There was no sign of other complications. Conclusions THA may be a good method for the advanced osteonecrosis of the femoral head combined with severe arthritis, and it has a good clinical result, but sufficient preoperation plan and good operation skill are necessary.