CAJ | 학술논문

目的比较生物型双极人工股骨头置换与全髋置换术治疗老年FicatⅢ期股骨头缺血性坏死患者的中远期疗效.方法对获得随访的61例(64髋)FicatⅢ期股骨头缺血性坏死患者,其中23例(24髋)行生物型双极人工股骨头置换、38例(40髋)行全髋关节置换术对其行回顾分析比较,观察手术前后Harris评分和术后髋部疼痛、影像学变化等情况.结果术后随访5～13年(平均8年),末次随访Harris评分全髋置换组(88.5±8.9)分,较股骨头置换组(73.5±8.3)分高,差异有统计学意义(t=6.69,P＜0.05).在疼痛发生率及翻修率上股骨头置换组分别为37.5％ (9/24)、29.2％ (7/24),均较全髋置换组10％ (4/40)、7.5％ (2/40)高,差异有统计学意义(X2=5.4l、X2=5.39,P均＜0.05).随访X线检查假体位置,股骨头置换组9例出现髋臼磨损,发生率为37.5％；全髋置换组髋臼松动率为2.5％(1/40),假体柄松动率为5％(2/40)；股骨头置换组5例出现股骨柄松动,发生率为20.8％(5/24),两组在股骨柄松动发生率上差异无统计学意义(X2=2.41,P＞0.05)；在股骨侧骨溶解发生率上股骨头置换组20.8％ (5/24)与全髋关节置换组22.5％ (9/40)间的差异无统计学意义(X2 =2.44,P ＞0.05).结论治疗老年FicatⅢ期股骨头缺血性坏死选择双极股骨头置换术应慎重,对于大多数患者,应积极选用生物型全髋置换术.
목적 비교생물형쌍겁인공고골두치환여전관치환술치료노년FicatⅢ기고골두결혈성배사환자적중원기료효.방법 대획득수방적61례(64관)FicatⅢ기고골두결혈성배사환자,기중23례(24관)행생물형쌍겁인공고골두치환、38례(40관)행전관관절치환술대기행회고분석비교,관찰수술전후Harris평분화술후관부동통、영상학변화등정황.결과 술후수방5～13년(평균8년),말차수방Harris평분전관치환조(88.5±8.9)분,교고골두치환조(73.5±8.3)분고,차이유통계학의의(t=6.69,P＜0.05).재동통발생솔급번수솔상고골두치환조분별위37.5％ (9/24)、29.2％ (7/24),균교전관치환조10％ (4/40)、7.5％ (2/40)고,차이유통계학의의(X2=5.4l、X2=5.39,P균＜0.05).수방X선검사가체위치,고골두치환조9례출현관구마손,발생솔위37.5％；전관치환조관구송동솔위2.5％(1/40),가체병송동솔위5％(2/40)；고골두치환조5례출현고골병송동,발생솔위20.8％(5/24),량조재고골병송동발생솔상차이무통계학의의(X2=2.41,P＞0.05)；재고골측골용해발생솔상고골두치환조20.8％ (5/24)여전관관절치환조22.5％ (9/40)간적차이무통계학의의(X2 =2.44,P ＞0.05).결론 치료노년FicatⅢ기고골두결혈성배사선택쌍겁고골두치환술응신중,대우대다수환자,응적겁선용생물형전관치환술.
Objective To compare the mid-long term result of cementless bipolar hemiarthroplasty and total hip arthroplasty for Ficat stage Ⅲ osteonecrosis of the femoral head in old age patients.Methods 61 patients (64 hips) with Ficat stage Ⅲ osteonecrosis of the femoral head were followed up.23 patients (24 hips) and 38 patients (40 hips) were treated with cementless bipolar hemiarthroplasty and total hip arthroplasty respectively.The pre- and postoperative Harris hip score,postoperative hip pain,and radiographic changes were observed.Results Patients were followed up 5-13 years ( average eight years).In the last follow-up,the Harris hip score of total hip arthroplasty group was (88.5 ±8.9) which was higer than that of hemiarthroplasty group ( 73.5 ± 8.3 ) ( t =6.69,P ＜ 0.05 ).As for the incidence of postoperative pain and revision rate,hemiarthroplasty group was 37.5％ ( 9/24 ),and 29.2％ ( 7/24 )respectively which was higher than that of total hip arthroplasty group which was 10％ (4/40) and 7.5％(2/40) respectively; the differences were statistically significant ( X2 =5.41,X2 =5.39,both P ＜ 0.05 ).The prostheses were examined by X-ray during follow-up.There were nine cases of acetabular wear in hemiarthroplasty group,and the incidence rate was 37.5％ ; while the rate of stem loosening was 5％ (2/40).Acetabular and stem loosening in total hip arthroplasty group were 2.5％ (1/40),5％ (2/40)respectively.There was no significant difference in stem loosening of the two groups ( X2 =2.41,P ＞0.05).The incidence of the femoral osteolysis in hemiarthroplasty group was 20.8％ (5/24) and was22.5％ (9/40) in total hip arthroplasty group.There was no significant difference(X2 =2.44,P ＞0.05).Conclusions It should be cautious when using bipolar hemiarthroplasty to treat Ficat stage Ⅲ osteonecrosis of the femoral head for old age patients.For most patients,cementless total hip arthroplasty should be more preferred.