金属对金属新假体临床使用体会

目的:探讨金属对金属大头(ASRTMXL)全髋关节置换术的早期疗效和临床体会,以及该技术的安全性和有效性。方法:2007年1月至2008年3月,采用金属对金属大头全髋关节置换术治疗37例(39髋)髋关节疾患,男24例,女13例;年龄43～75岁,平均58.5岁。其中股骨头坏死14例、骨性关节炎2例、新鲜股骨颈骨折18例、先天性髋关节发育不良3例。结合手术前后患者髋关节功能检查、Harris评分及X线分析,对金属大头全髋的临床应用特点进行分析。结果:术后患者伤口均Ⅰ期临床愈合,无早期并发症发生。37例(39髋)均获随访,随访时间12～19个月,平均16.5个月。术后X线片显示关节假体位置良好,肢体长度及股骨偏心距基本恢复正常。髋关节活动度得到大幅改善,前屈由(20.1±8.2)°增加到(85.7±9.8)°(t=32.86,P0.01),外展由(10.2±4.4)°增加到(41.5±9.1)°(t=19.34,P0.01),内收由(16.3±8.8)°增加到(40.3±10.4)°(t=11.00,P0.01),外旋由(12.3±5.2)°增加到(42.0±7.7)°(t=19.96,P0.01),内旋由(3.4±1.1)°增加到(23.0±9.8)°(t=12.41,P0.01)。Harris髋关节评分从术前(39.3±5.6)分提高到最后随访的(91.4±10.3)分(t=27.75,P0.01)。结论:金属对金属大头全髋假体设计具有臼杯变形小、磨损率低、活动范围大、脱位发生率低等特点。其为治疗术后活动量要求较高的髋关节疾病如股骨头缺血性坏死、骨关节炎、股骨颈骨折、髋发育不良患者提供了一种新的有价值的手术方式。

Clinical apprehension on application of metal on metal total hip arthroplasty with large diameter heads

Objective:To approach the short term result and clinical application of metal on metal total hip arthroplasty with large diameter heads and evaluate its safety and efficacy clinically.Methods:From January 2007 to March 2008,39 hips in 37 patients(24 males and 13 females,ranging in age from 43 to 75 years,with an average of 58.5 years) were treated with metal on metal total hip arthroplasty with large diameter heads(ASRTM XL) included 14 cases of osteonecrosis(ON),2 cases of osteoarthritis(OA),18 cases of fr...