不同界面全髋关节置换在股骨头无菌性坏死患者中的应用

目的观察陶瓷-陶瓷与金属-聚乙烯材料治疗股骨头无菌性坏死的临床疗效，为全髋关节置换术选择不同关节面材料提供参考。方法选取在我科行全髓关节置换术治疗的45例股骨头无菌性坏死患者进行回顾性分析，按照不同关节面材料分为陶瓷组22例和金属组23例。陶瓷组采用陶瓷一陶瓷（Ceramic-on—ceramic articulation，coc）人工髋关节假体，金属组采用金属-聚乙烯（Metalonhigh—molecular-weight polyethylene articulation，MOP）人工髋关节假体，比较两组患者术后Harris评分、随访期间影像学变化、假体松动等相关并发症。结果所有患者平均随访时间为42个月（36-48个月），术后均未出现骨折、脱位、感染、下肢深静脉血栓等并发症；两组患者术后患肢活动能力显著改善，髋关节疼痛消失，术后1年Harris评分较术前显著升高（P〈0．05）；金属组部分患者术后3年Harris评分降低，经比较发现，陶瓷组术后3年Harris评分显著高于金属组（P〈0．05），其术后3年的优良率稍高于金属组，但差异无统计学意义。陶瓷组柄体下沉，吸收性骨反应以及骨假体稳定性显著高于金属组，其差异具有统计学意义（P〈0．05）。结论金属-聚乙烯与陶瓷-陶瓷关节界面术后优良率相似，但陶瓷界面磨损、骨溶解、假体松动发生率较低，应根据患者实际情况选择材料。

Application of total hip arthroplasty with different interface in the treatment of patients with osteonecrosis of the femoral head.

Objective To compare the clinical effect of alumina ceramic-on-ceramic （COC） articulation and metal on high-molecular-weight polyethylene articulation （MOP） at the intermediate term for osteonecrosis of the fem- oral head, and to provide reference for the selection of interface materials in total hip arthroplasty （THA）. Methods The clinical data of forty-five patients with osteonecrosis of the femoral head treated by THA were retrospectively reviewed. The patients were divided into two groups according to the interface materials used： MOP group （MOP articu- lation, n=23） and COC group （COC articulation, n=22）. The clinical and radiographic results, implant related failure, and Harris Hip Score were used to assess the clinical effect. Results The patients were followed up for 36--48 months, with an average of 42 months. There were no fracture, infections, ceramic fracture or DVT occurred. The post- operative limb activity improved significantly in the two groups, and the hip pain disappeared. The Harris Hip Score of 1 year after operation were improved in both two groups, but the Harris Hip Score of 3 years after operation in MOP group were decreased, lower than COC group （P〈0.05）. The excellent and good rate 3 years after operation was slightly higher in COC group than MOP group, with no significant difference. The incidence of loosening, subsidence of the feromal component and osteolysis in MOP group were higher than COC group （P〈0.05）. Conclusion MOP and COC have similar clinical effect, but COC has lower incidence of loosening, subsidence of the feromal component and osteolysis. The selection of the materials should be made individually according to the actual situation of patients.