CAJ | 학술논문

目的评价陶瓷对陶瓷短柄全髋关节置换术治疗中青年股骨头坏死晚期患者的近期疗效.方法 2009年12月至2011年3月接受陶瓷对陶瓷短柄初次全髋关节置换术治疗的中青年股骨头坏死患者40例(43髋),男23例,女17例；年龄27～55岁,平均40.5岁.Steinberg分期均为Ⅳ期以上.29例采用后外侧入路,11例采用前侧入路.术后3、6、12个月及以后每年随访1次,摄骨盆正位及髋关节侧位X线片,测量假体下沉距离；采用Harris髋关节评分和WOMAC骨关节炎指数评估关节功能.结果 38例(41髋)得到随访,随访时间21～36个月,平均31.3个月.末次随访X线片上假体位置较术后即刻下沉(0.68±2.90) mm,差异无统计学意义(t=1.51,P=0.139).术后髋关节疼痛均明显改善或消失,Harris髋关节评分由术前平均(38.7±12.1)分提高至末次随访(95.2±4.49)分,WOMAC骨关节炎指数由术前平均66.7±12.0降至末次随访12.8±5.6,差异均有统计学意义.随访期间未发生股骨颈骨折、感染、肺栓塞等严重并发症,无假体关节脱位、松动及假体感染.结论短柄全髋关节置换术可更多地保留骨量,假体初始稳定性好,全陶瓷头衬配伍的磨损率低,近期疗效佳,假体相关并发症少.
목적 평개도자대도자단병전관관절치환술치료중청년고골두배사만기환자적근기료효.방법 2009년12월지2011년3월접수도자대도자단병초차전관관절치환술치료적중청년고골두배사환자40례(43관),남23례,녀17례；년령27～55세,평균40.5세.Steinberg분기균위Ⅳ기이상.29례채용후외측입로,11례채용전측입로.술후3、6、12개월급이후매년수방1차,섭골분정위급관관절측위X선편,측량가체하침거리；채용Harris관관절평분화WOMAC골관절염지수평고관절공능.결과 38례(41관)득도수방,수방시간21～36개월,평균31.3개월.말차수방X선편상가체위치교술후즉각하침(0.68±2.90) mm,차이무통계학의의(t=1.51,P=0.139).술후관관절동통균명현개선혹소실,Harris관관절평분유술전평균(38.7±12.1)분제고지말차수방(95.2±4.49)분,WOMAC골관절염지수유술전평균66.7±12.0강지말차수방12.8±5.6,차이균유통계학의의.수방기간미발생고골경골절、감염、폐전새등엄중병발증,무가체관절탈위、송동급가체감염.결론 단병전관관절치환술가경다지보류골량,가체초시은정성호,전도자두츤배오적마손솔저,근기료효가,가체상관병발증소.
Objective To evaluate the clinical effects and experiences of short stem ceramic-on-ceramic total hip arthroplasty in the treatment of young and middle-aged patients with femoral head necrosis.Methods From December 2009 to March 2011,40 patients with femoral head necrosis were treated primarily with short stem ceramic-on-ceramic hip arthroplasty (43 hips) through posterior-lateral or anterior-lateral approach.There were 23 males,17 females； with the mean age of 40.5 years (range,27-55 years).All cases were stage Ⅳ or more according Steinberg stage.The patients were followed up at the 3,6,12 months after operation,and then once each year.Standard X-ray films were taken at the follow-ups.Femoral prosthesis subsidence was assessed through X-ray films.Harris scores system and WOMAC Osteoarthritis Index were recorded before and after operation to evaluate clinical effects of surgery.Results Thirty-eight patients (41 hips) were followed up for 21-36 months,with an average of 31.3 months.The femoral stem subsided 0.68±2.90 mm at the last follow-up.After operation,hip pain of patients was relieved obviously.The Harris score improved from 38.7±12.1 (15-66) preoperatively to 95.2±4.49 (83-100) postoperatively,WOMAC Index from 66.7±12.0 (49-94) to 12.8±5.6 (0-24).During follow-up period,there was no serious complication such as femoral neck fracture,infection of wound,pulmonary embolism,et al.No dislocation,implant prosthesis failure and infection were observed.Conclusion The short stem hip arthroplasty preserves bone stock to a great extent.The short stem implant showed a good stability and osseous integration.The wear rate of ceramic-on-ceramic bearing surface is extremely low.Short stem hip arthroplasty plus ceramic-on-ceramic bearing surface might be a good option for the young and middle-aged patients with femoral head necrosis.