H/G非骨水泥型人工全髋关节置换术后中期随访结果

目的：观察H/G非骨水泥型人工全髋关节置换术后中期的随访结果。方法：对35例40髋H/G非骨水泥型人工髋关节置换术后进行了6年-10年2个月，平均7.5年的随访。临床随访根据Harris的评分方法进行评分，X线随访根据Amstutz的分区方法将股骨侧分为7个区，髋臼侧分为4个分区进行观察。结果：临床随访：Harris评分术后3年平均95分，5年平均89分，7.5年平均83分。Harris评分低于85分者6髋，其中4髋髋臼假体松动，1髋塑料内衬脱落，1髋负重疼痛。X线随访：股骨侧，股骨假体周围出现区域性透亮还25髋（62.5%），无出现全周透亮带的病例；髓腔骨骨化20髋（50.0%）；假体远端骨皮质增厚18髋（45.0%）；7区即股骨距处骨溶解10髋（25.0%）；2髋出现7mm以内的假体下沉。髋臼侧，出现透亮带20髋（50.0%），其中区域性透亮带12髋，全周透亮带8髋，目前已有4髋施行了翻修手术；骨溶解7髋（17.5%），其中1区4髋，2区髋臼螺钉周围骨溶解3髋；骨吸收2髋（5.0%），为翻修术中植骨的病例；塑料内衬脱落1髋（2.5%）。结论：中期随访显示，临床及X线随访结果均较初期随访为差。松动关节明显增多，特别是在X线随访中，假体周围出现的异常骨反应明显高于初期随访所见。虽然目前大部分仅限于X线所见，临床上尚无症状，但应进行密切观察。此外，1髋因金属髋臼卡子松动导致塑料内衬脱落而行翻修术，此种情况应引起注意。

Intermediate-term results of H/G total hip arthroplasty without cement

Object iv e To observe the intermediate-term results of the H /G total hip arthroplast y.Methods Thirty-fivecases(40hips)with the H /G THA were reviewed with an average of 7.5years fol-low-up(range,6to10.2years).In th is grou p,the primary lesions of hip included avascular necrosis of femoral head(1 2hips,10cases),congenital dysplasia of hip(9hips,8cases),femoral ne ck fracture(8hips,8cases),osteoarthritis(4hips,4cases),reversion(3 hips,3cases)and ankylosing spondylitis(4hips,2cas-es).The clinical res ults were scored with Harris methods.The roentgenographic results were analyzed with Am stutz meth ods.Results Theclinical average Harris scores were95in3-year follow-up,89in5-year fol-low-up,83in7.5-year follow-up. Roentgenographic results of femoral components showed20hips with in-tra medu llary ossification,18hips with cortical hypertrophy around the distal prosthe ses,25hips with lo cal re-di olucent line,10hips with osteolysis in femu r calar and2hips with implants subsiding less than7mm.Roentgenographic resul ts of acetabular component revealed20hips with radi olucent line(8compo n ents with around radiolu cent,12components with local radiolucent ),7hips with osteolysis and1hip with polyethylene lining defluxion.Conclusion Theresul ts of clinical and roentgenographic performance in mid-dle-term is not as go od as that in short-term.The abnormal bone reaction is evidently higher in mid dle-term than in short-term.Though the above-mentioned manifestation is only restricted on the roentgenogram with-out clinic symptom,however,further fol low-up is need ed.It should be noted that one case had revi sion be-cause of the polyethylene lining defluxion resulted from clip loosening on the metal ace tabular com po nent ;although this seldom happens both at home and abroad,more attention should be paid to the revi sion case re-sulted from the mechanical m alfunction not from the prosthesis loosening.