人工髋关节表面置换术19例

目的总结人工髋关节表面置换术的初步经验与疗效。方法 2007年8月～2009年6月对19例(19髋)髋关节疾病行人工髋关节表面置换术,假体均为金属对金属髋关节表面假体。取髋关节后外侧入路,直视下或定位器下钻入导向钉,根据股骨颈直径确定股骨头假体的大小,髋臼假体使用生物型压配技术固定,股骨头假体骨水泥固定。结果 1例术后复查X线片时发现髋臼假体脱位再次手术复位成功;1例在股骨颈定位时发现导针严重偏差,重新定位定向后获得良好位置,术后X线位置良好;其余17例手术顺利和术后X线显示位置良好,出院时均屈髋达90°,步行出院。19例随访3～25个月,平均9.2月,末次随访HSS评分为(91±11)分,较术前(43±10)分明显增高(t=14.465,P=0.000);UCLA髋关节活动评分(7.4±1.6)分,较术前(4.4±1.3)分明显升高(t=8.364,P=0.000)。结论金属对金属髋关节表面置换术治疗某些髋关节疾病近期疗效优良,特别适合于年轻患者;但该术式有更长学习曲线,有一定的适用范围,且在行髋关节表面置换时需要准备全髋置换的器械。

Metal-on-metal Hip Resurfacing: Report of 19 Cases

Objective To summarize our experience of metal-on-metal hip resurfacing and the short-term clinical outcomes of the procedure.Methods From August 2007 to June 2009,we performed metal-on-metal hip resurfacing on totally 19 patients（19 hips）.All the operations were performed via the posterolateral approach.During the operation,the acetabulum was reamed into the templated size,and then the acetabular component was implanted by press fit.Afterwards,a neck-centering jig was used to place a pin into the femoral head to guide the femoral resurfacing reamer.And the femoral component was cemented in the dome area only.Results The operation was completed successfully in all of the cases except in two,who were found with dislocation of the acetabular prosthesis or biased guiding needle.Both of the cases were cured by a second procedure.The other 17 patients achieved a 90° of hip flexion,and all of them could walk on discharge.The 19 patients were followed up for 3 to 25 months with a mean of 9.2 months,during which the mean final HSS score was shown as 91±11,and the UCLA score 7.4±1.6,which were both significantly increased compared with those before the treatment（43±10,t=14.465,P=0.000 and 4.4±1.3,t=8.364,P=0.000）.ConclusionsMetal-on-metal hip resurfacing shows a good short-term outcomes in our hospital.The procedure is especially good for young patients.However,a long study curve is needed for this procedure,and the procedure can be used in a certain circumstance.Furthermore,instruments for total hip arthroplasty are required for this operation.