初次骨水泥型人工全髋关节置换术的中远期疗效分析

目的回顾性分析初次骨水泥型全髋关节置换术（THA）的中远期临床及影像学疗效、假体的生存率及其相关影响因素。方法对1991年7月至2006年6月间接受初次骨水泥型THA的患者187例（201髋）进行随访。观察并发症情况、影像学表现,并对Harris评分和骨密度结果值进行统计学分析,以假体翻修为随访终点,计算假体的生存率。结果共117例（126髋）获得完整随访,平均随访时间为13.5年。Harris评分由术前的（32.8±22.5）分提高至末次随访时的（90.3±7.3）分,差异有统计学意义（t=-27.91,P〈0.01）。假体周围界面有不同表现的患者的骨密度结果比较无统计学差异（F=0.289,P〉0.05）。晚期感染1髋,脱位3髋,下肢深静脉血栓4髋,下肢不等长4髋,假体周围骨折2髋,异位骨化6髋,无菌性松动5髋。共有7髋接受髋关节翻修手术,平均翻修手术时间为初次置换术后11.3年,假体的生存率为94.4%。结论骨水泥型THA在治疗高龄骨质疏松患者髋关节疾病方面可以取得良好的临床效果,骨水泥假体的远期生存率令人满意。

Mid-long term effect analysis of primary cemented total hip arthroplasty

Objective To evaluate the mid-long term clinical and radiographic effects of the primary cemented total hip arthroplasty（THA）.Methods One hundred and eighty-seven patients（201hips） who had undergone primary cemented THA from July 1991 to June 2006 were followed up for their post-operative complications and imaging findings.Harris score and bone density value were used for statistical analysis.The survival rate of the implants was determined by using the revision of either prosthetic component for any reason as the end-point during the follow-up.Results One hundred and seventeen patients（126 hips） were followed up for 13.5 years averagely in the end.Harris score improved significantly from（32.8 ± 22.5） points to（90.3 ± 7.3） points（t =-27.91,P〈0.01）.The bone density value had no significant difference among the different groups according to the different periprosthetic interface images（F = 0.289,P〉0.05）.There was late infection in one hip,dislocation in three hips,DVT in four hips,inequality of lower limb in four hips,periprosthetic fracture in two hips,heterotopic ossification in six hips and aseptic loosening in five hips.Seven hips were revised after a mean time of 11.3 years.The survival rate of the implants was 94.4%.Conclusion The study suggests that the cemented THA may be suitable for treating all kinds of severe diseases of the hip joint for the senile osteoporosis patients and it can acheive good clinical outcomes.The cemented implant has satisfactory longterm results.