中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2009年
24期
1888-1891
,共4页
关节成形术%置换%髋%髋假体%磨损%骨溶解
關節成形術%置換%髖%髖假體%磨損%骨溶解
관절성형술%치환%관%관가체%마손%골용해
Arthroplasty%replacement%hip%Hip prosthesis%Polyethylene wear%Osteolysis
目的 对H/G非骨水泥人工全髋关节置换术后聚乙烯内杯的磨损及髋臼周围骨溶解的情况进行总结.方法 我院1991至1995年共进行58例(65髋)H/G非骨水泥人工全髋关节置换,其中35例(40髋)获得10年以上随访.对这35例(40髋)患者获得随访的病例,采用计算机数字化方法测量髋臼聚乙烯内杯的二维线性磨损.结果 35例40髋均有不同程度的磨损,磨损范围2～8 mm,平均磨损为(0.32±0.31)mm/年.10髋聚乙烯磨损超过6 mm,髋臼假体周围的骨溶解严重,并伴有金属假体的移位,其中5髋聚乙烯内杯完伞磨透,金属股骨头与金属髋臼相接触;5髋聚乙烯内杯磨损严重伴明显骨溶解,内杯松动.2髋聚乙烯内杯脱位.共实施翻修手术12例,包括更换聚乙烯内杯和金属股骨头2例、金属闩杯翻修2例、全髋翻修8例.28髋在髋臼侧发现骨溶解,其中14髋股骨侧亦有骨溶解发生.结论 本组病例所观测到的H/G髋臼聚乙烯内杯的磨损程度超过文献所报道,而且由于磨损产生的大量磨屑,导致假体周围出现明显骨溶解,直接影响到假体的稳定.关节置换术后应定期随访,避免出现严重骨溶解后增加翻修手术的困难.
目的 對H/G非骨水泥人工全髖關節置換術後聚乙烯內杯的磨損及髖臼週圍骨溶解的情況進行總結.方法 我院1991至1995年共進行58例(65髖)H/G非骨水泥人工全髖關節置換,其中35例(40髖)穫得10年以上隨訪.對這35例(40髖)患者穫得隨訪的病例,採用計算機數字化方法測量髖臼聚乙烯內杯的二維線性磨損.結果 35例40髖均有不同程度的磨損,磨損範圍2～8 mm,平均磨損為(0.32±0.31)mm/年.10髖聚乙烯磨損超過6 mm,髖臼假體週圍的骨溶解嚴重,併伴有金屬假體的移位,其中5髖聚乙烯內杯完傘磨透,金屬股骨頭與金屬髖臼相接觸;5髖聚乙烯內杯磨損嚴重伴明顯骨溶解,內杯鬆動.2髖聚乙烯內杯脫位.共實施翻脩手術12例,包括更換聚乙烯內杯和金屬股骨頭2例、金屬閂杯翻脩2例、全髖翻脩8例.28髖在髖臼側髮現骨溶解,其中14髖股骨側亦有骨溶解髮生.結論 本組病例所觀測到的H/G髖臼聚乙烯內杯的磨損程度超過文獻所報道,而且由于磨損產生的大量磨屑,導緻假體週圍齣現明顯骨溶解,直接影響到假體的穩定.關節置換術後應定期隨訪,避免齣現嚴重骨溶解後增加翻脩手術的睏難.
목적 대H/G비골수니인공전관관절치환술후취을희내배적마손급관구주위골용해적정황진행총결.방법 아원1991지1995년공진행58례(65관)H/G비골수니인공전관관절치환,기중35례(40관)획득10년이상수방.대저35례(40관)환자획득수방적병례,채용계산궤수자화방법측량관구취을희내배적이유선성마손.결과 35례40관균유불동정도적마손,마손범위2～8 mm,평균마손위(0.32±0.31)mm/년.10관취을희마손초과6 mm,관구가체주위적골용해엄중,병반유금속가체적이위,기중5관취을희내배완산마투,금속고골두여금속관구상접촉;5관취을희내배마손엄중반명현골용해,내배송동.2관취을희내배탈위.공실시번수수술12례,포괄경환취을희내배화금속고골두2례、금속산배번수2례、전관번수8례.28관재관구측발현골용해,기중14관고골측역유골용해발생.결론 본조병례소관측도적H/G관구취을희내배적마손정도초과문헌소보도,이차유우마손산생적대량마설,도치가체주위출현명현골용해,직접영향도가체적은정.관절치환술후응정기수방,피면출현엄중골용해후증가번수수술적곤난.
Objectives To measure the linear polyethelene wear with use of a computer-assisted two-dimensional method, and to evaluate the relationship between wear and long-term clinic-radiological findings. Methods Between December 1991 and December 1995, the senior author performed 40 primary total hip arthroplasties with use of H/G porous-coated acetabular component Radiographs of 40 H/G cementless total hip arthroplasies were examined for osteolysis, radiolucent line, cup migration and so on. To measure the linear polyethylene wear, migration in the femoral head center relative to the cup shell center was calculated on digitized consecutive radiographs with special computer software program. Results The minimum follow-up was 10 years. Total linear wear was 2-8 mm, the mean rate of linear polyethylene wear was (0. 32 ±0. 31) mm/year. Twelve acetabular components (30% ) were revised at an average follow-up point of 12 years. Three types of polyethylene liner failure were identified: wear-through of the polyethylene liner with resultant metallosis (5 hips) , excessive wear necessitating revision (5 hips), and polyethylene liner dissociation without gross evidence of wear (2 hips). Conclusions High wear rates and femoral and acetabular osteolysis have been and still are the main problems in uncemented total hip replacement There is clear relationship between wear and acetabular osteolysis or loosening of the prostheses. The poor long-term results with these uncemented total hip arthroplasties illustrate the necessity of regular radiographic evaluation in order to detect osteolysis and liner failure, which are both generally asymptomatic until catastrophic failure appears.
