CAJ | 학술논문

目的评价羟基磷灰石涂层股骨柄假体伞髋关节置换术的中期疗效.方法 2000年2月至2001年2月,采用U2钛合金羟基磷灰石涂层股骨柄假体行非骨水泥全髋关节置换术65例(70髋),男20例,女45例;年龄40～82岁,平均63岁.术前诊断:股骨颈骨折30例,髋关节骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿髋关节炎2例,髋关节融合术后1例.分别于术后1周、3个月、6个月随访,以后每年随访1次,对髋关节功能(Harris评分)和X线片进行复查.结果 4例死于癌症,余61例(66髋)获7～8年随访,平均7.5年.末次随访时髋关节Harris评分85～100分,平均96分.3髋(4.5%)出现轻度大腿痛,无一髋需行翻修术治疗.术后1年内假体下沉小于1.5 mm者7髋,此后未再出现假体下沉.术后3～6个月在Gruen 2区和6区近段羟基磷灰石涂层部位出现典型的骨锚固征及松质骨和皮质骨密度增高影像.此后所有患者包括年龄大于70岁和Dorr C型髓腔者均无柄端周围的骨质增生或"底座征",也尤股骨近段或远段髓内骨溶解及假体松动.按Engh标准评定全部患者均获骨性固定.结论羟基磷灰石涂层能增强股骨柄假体的初始固定,促进早期骨长入和生物学固定,阻止聚乙烯磨屑的髓内迁移和远段髓内骨溶解,用于非骨水泥全髋置换术中期疗效满意.
목적 평개간기린회석도층고골병가체산관관절치환술적중기료효.방법 2000년2월지2001년2월,채용U2태합금간기린회석도층고골병가체행비골수니전관관절치환술65례(70관),남20례,녀45례;년령40～82세,평균63세.술전진단:고골경골절30례,관관절골관절염15례,고골두결혈성배사9례,인공고골두술후송동8례,류풍습관관절염2례,관관절융합술후1례.분별우술후1주、3개월、6개월수방,이후매년수방1차,대관관절공능(Harris평분)화X선편진행복사.결과 4례사우암증,여61례(66관)획7～8년수방,평균7.5년.말차수방시관관절Harris평분85～100분,평균96분.3관(4.5%)출현경도대퇴통,무일관수행번수술치료.술후1년내가체하침소우1.5 mm자7관,차후미재출현가체하침.술후3～6개월재Gruen 2구화6구근단간기린회석도층부위출현전형적골묘고정급송질골화피질골밀도증고영상.차후소유환자포괄년령대우70세화Dorr C형수강자균무병단주위적골질증생혹"저좌정",야우고골근단혹원단수내골용해급가체송동.안Engh표준평정전부환자균획골성고정.결론 간기린회석도층능증강고골병가체적초시고정,촉진조기골장입화생물학고정,조지취을희마설적수내천이화원단수내골용해,용우비골수니전관치환술중기료효만의.
Objective To summarize the mid-term result of total hip replacement with a proximally hydroxyapatite-coated femoral component. Methods From February 2000 to February 2001, 65 cases (70 hips) underwent uncement total hip replacement with a proximally hydroxyapatite-coated femoral component. There were twenty males and forty-five females with average of 63 years. The diagnosis included femoral neck fractures in 30 cases, osteoarthritis in 15 cases, avascular necrosis of the femoral head in 9 cases, loos-ening of artificial femoral head in 8 cases, rheumatoid arthritis in 2 cases, and arthrodesis in 1 case. Clinical and radiographic evaluations were performed postoperatively, at one week, three, six, twelve months, and yearly thereafter. Results Four patients died before the latest follow-up. Among the 61 cases (66 hips), the average follow-up was 7.5 years. At the latest follow-up, the mean Harris hip score was 96 points. 3 patients (4.5%) reported mild thigh pain, no ease need revision. By the measurement of the X-ray, 7 stems had less than 1.5 mm of subsidence within the 1 year follow-up. The remainer stems had no subsidence. Radiographic evaluation demonstrated all stems to get bone ingrowths fixation with evidence of spot welds, cancellous con-densation and cortical hypertrophy visible around Gruen zone 2 and zone 6 at 3 to 6 months postoperatively, including patients aged more than 70 years and of Dorr type C. Reactive lines covered the noncoated zone of the femoral stems for some eases. No hip had extensive proximal end osteolysis or distal intramedullary oste-olysis, and loosening. Conclusion Hydroxyapatite-coating on femoral implants is able to enhance the initial fixation of implants, to accelerate bone ingrowths and osseous fixation of the femoral component, to seal the interface between the implant and bone and to prevent ingress of polyethylene particles. So it is good to im-prove mid-term clinical results of the eementless total hip replacement.