初次混合式全髋关节置换术骨水泥柄的生存率分析

目的 探讨骨水泥柄全髋关节置换术后中期临床疗效.方法 接受骨水泥柄髋关节置换患者148例167髋,男95例106髋,女53例61髋;年龄28~87岁,平均62.8岁;体重45.2~87.4 kg,平均57.2 kg;身高146~184cm,平均161.5cm;平均体重指数21.4.临床疗效以Harris评分为标准,根据影像学资料评估股骨柄假体位置、骨水泥壳、假体周围骨重塑和骨溶解发生情况.以股骨假体无菌性松动和任何原因所致的假体翻修为终点,对假体生存率采用Kaplan-Meier分析.结果 106例114髋获得随访,随访时间6.5~9.5年,平均8.1年.术前Harris评分8~54分,平均42分;末次随访时76~100分,平均94分.无一例发生无菌性松动及假体翻修.6髋假体柄平均下沉1.83mm.16髋(14%)股骨侧出现<1mm的影像学透亮线,9髋(8%)Gruen Ⅰ区和Ⅶ区出现局灶性骨溶解所致斑点样影像学透亮区.106髋(93%)股骨侧有不同程度的皮质变薄或皮质松质骨化,均位于Ⅶ区.假体生存率为100%(95%可信区间.0.95-1.00).结论 采用第三代骨水泥技术固定股骨柄,可取得较好中期临床效果,但仍存在骨溶解、股骨近端皮质骨吸收重塑等潜在问题.

Survival analysis of third generation cemented stem in primary hybrid total hip arthroplasty

Objective To analyse the survival of third generation cemented stem in primary hybrid total hip arthroplasty and document the clinical and radiographic results of third generation cementing technique in 148 consecutive patients, Methods 148 consecutive patients (167 hips) underwent primary hybrid total hip arthoplasty, using a single design of the femoral component (Reliance stem), inserted with a socalled third-generation cementing technique. There were ninety-five men and fifty-three women. The mean age at the time of the arthroplasty was 62.8 years (range, 28 to 87 years). The mean weight was 57.2kg (range, 45.2 to 87.4kg). Clinical and radiographic evaluations were performed preoperatively; at six weeks postoperatively; at three, six, twelve months; and yearly thereafter. Kaplan-Meier analysis was performed to evaluate the survival of the cemented stem. Radiographic loosening or revision for any reason was regarded as end point of the study. Results There were 106 patients (114 hips) were got followed. All remaining patients were followed up 6.5 to 9.5 years, with the mean years of 8.1. The mean Harris score was improved from 42 (range, 8 to 54 points) preoperatively to 94 (range, 76 to 100 points) postoperatively. No stem component had aseptic loosening and had been revised. Radiographically, 9 hips (8%) had osteolysis adjacent to the stem, mostly in Gruen zones I and Ⅶ. Sixteen hips (14%) showed one or more radiolucent line (<1mm). 6 stems (5%) had a mean 1.83mm subsidence (range, 1 to 2mm). The survival rate of the femoral components loosening or revision for any reason was 100% (95% confidence interval, 0.95-1.00). Conclusion The clinical and radiological results are excellent after 8.1 years following up. The advancements in surgical and cementing technique have greatly improved the mid-term survival of cemented stem. Although there is no asceptic loosening of the femroal component, however, a relative high rate of osteolysis remain challenging problems. Furthermore, the long-term effects should be further needed and observed.