骨水泥型人工全髋置换技术的临床疗效分析

目的:通过文献检索和临床验证评价骨水泥型人工髋关节假体的治疗效果.方法:以"全髋关节置换,人工假体;骨水泥"为中文关键词,以"total hip replacement,prosthesis,bone cement"为英文关键词,检索维普数据库和Pubmed数据库1998-01/2009-12相关文献.纳入骨水泥型和非骨水泥型人工髋关节临床应用相关文献;排除重复研究或Meta分析类文献.重点对以下问题进行了探讨:①人工关节置换的分类.②骨水泥髋关节假体材料的发展.⑧骨水泥髋关节假体材料治疗效果和临床验证结果.④股骨距解剖生理特点及髋关节置换操作注意要点.同时对都匀市黔南州人民医院人工全髋关节置换55例采用骨水泥型人工髋关节治疗效果进行了分析.结果:人工关节置换分为骨水泥型人工髋关节和非骨水泥型人工髋关节.骨水泥型适用于骨质疏松、老年患者.非骨水泥型适用于骨质条件比较好的中青年患者.针对金属与骨水泥界面抗剪强度差问题,第三代骨水泥技术对假体表面粗糙进行了处理,以增加界面抗剪强度,取得了一定的效果.临床验证结果,通过12个月～6年的随访,按Harrisyg评分标准,优39例,良13例,可3例.术后常规予X射线定期复查,出现髋痛3例、假体脱出1例、松动1例、关节脱位1例,无感染和股骨骨折.结论:随着多种新型骨水泥材料逐渐面世,骨水泥的性能必将更加完善,接近或达到自体骨,有望成为理想的骨替代材料.

Clinical effect of total hip replacement technique with bone cemented prosthesis

OBJECTIVE:To evaluate the effect of bone cement prosthesis by retrieving literatures and clinical validations.METHODS:With the key words"total hip replacement,prosthesis,bone cement"in Chinese and English,articles were searched in VIP and Pubmed databases published between January 1998 and December 2009 Articles related to cemented and cementedless prosthesis were included Repetitive articles and Meta analysis were excluded.The questions were discussed,including classification of artificial joint replacement,development of cemented hip prosthesis materials,treatment effect and clinical validation of cemented hip prosthesis materials,anatomic features of calear femorale and operation of hip Joint replacement.In addition,55 cases undergoing total hip replacement with cemented prosthesis in Qiannan Prefecture People's Hospital were analyzed.RESULTS:Artificial joint replacement includes cemented and cementedless prosthesis.Cemented prosthesis is applicable for ostecoporotic and elderly patients.Cementedless prosthesis can be used for middle-aged or young patients.As the shear strengtn Of metal and bone cement surface is bad,novel bone cement modifies the prosthesis surface to enhance the shear strength Clinical results showed that during the follow up of 12 months to 6 years,there were 39 cases of excellent,13 of good and 3 of fair according to Harrisyg scores.Postoperative X-ray showed hip pain in 3 patients,prosthesis prolapse in 1,prosthesis loosening in1 and dislocation in 1.No infection or femoral fracture was detected.CONCLUSION:With development of various novel bone cement materials,the performance of bone cement is improving,and may become ideal bone substitutes.