金属对金属髋关节表面置换术的短期随访研究

目的探讨金属对金属(MOM)混合固定型髋关节表面置换术(HRA)的近期疗效,分析手术技术要点。方法 2004年10月至2008年6月,对52例(58髋)股骨头缺血性坏死、骨关节炎、髋关节发育不良、强直性脊柱炎患者行MOM-HRA。其中男32例,女20例;年龄16～65岁,平均42.6岁。手术方法按照K.De.Smet标准方法进行,术后对Harris评分、关节活动度和X线片进行随访。结果失访7例(8髋),45例(50髋)获得随访,随访时间平均22个月(12～54个月)。术前平均Harris评分(37.0±1.2)分,术后22个月平均(93.0±1.0)分;术前屈髋度平均(25.3±1.6)°,术后22个月平均(105.0±1.8)°;术前外展度平均(18.8±0.8)°,术后22个月平均(40.6±1.0)°。评价:46髋优,3髋良,1髋差。无股骨颈骨折,无松动,无脱位,无感染,无翻修,1例异位骨化BrookerⅢ型。结论 HRA具有保留股骨头骨量、术后关节活动度恢复快、近期结果好等优点,对于获得优良的术后结果,严格的患者选择和精确的手术技术至关重要。

Preliminary results after metal-on-metal hip resurfacing arthroplasty

Objective To evaluate the preliminary clinical results of metal-on-metal hip resurfacing and review the technique factors which affect the results.Methods From October 2004 to June 2008,52 patients （58 hips） with femoral head osteonecrosis,osteoarthritis,hip dyplasia,ankylosing spondylitis were treated with the total hip resurfacing arthroplasty.Among them,32 were male,and 20 were female,with an average age of 42.6 years （range from 16-65 years）.Standard operation technique which was brought forth by K.De.Smet was employed,and all patients were followed up after operation.Results Seven （8 hips） patients were lost.45 （50 hips） patients were followed up for an average period of 22 months （12-54 months）.There were one heterotopic ossification （Brook Ⅲ）,no femoral neck fracture,or dislocation,or infection or revision was found.From preoperation to present,the mean flexion angle of hip was improved from （25.3±1.6）° to （105.0±1.8）°,the mean abduction angle of hip was improved from （18.8±0.8）° to （40.6±1.0）°,and the average Harris hip score improved significantly from （37.0±1.2） to （93.0±1.0）,among which 46 hips were excellent,three hips were good,and one hip was poor.Conclusions The total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients.The short-term results are satisfactory.Strict patient selection criteria and optimized technique are considerable substantial.