中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (30): 5539-5542.doi: 10.3969/j.issn.1673-8225.2010.30.008

• 人工假体 artificial prosthesis • 上一篇    下一篇

高龄患者锥形股骨柄假体全髋置换后的中期疗效

刘宏鸣，孙俊英，杨立文，曾金才，骆  园，杨茂伟，李永旺   

  1. 苏州大学附属第一医院骨科，江苏省苏州市 215006
  • 出版日期:2010-07-23 发布日期:2010-07-23
  • 通讯作者: 孙俊英，教授，博士生导师，苏州大学附属第一医院骨科，江苏省苏州市 215006 Sun_Junying@hotmail.com
  • 作者简介:刘宏鸣★，男，1981年生，江苏省泰兴市人，汉族，在读硕士，医师，主要从事关节外科的研究。 lhmlhm-2002@163.com

Mid-term effect of total hip replacement with a tapered femoral component for elderly patients

Liu Hong-ming, Sun Jun-ying, Yang Li-wen, Zeng Jin-cai, Luo Yuan, Yang Mao-wei, Li Yong-wang   

  1. Department of Orthopedics, First Hospital Affiliated to Soochow University, Suzhou  215006, Jiangsu Province, China
  • Online:2010-07-23 Published:2010-07-23
  • Contact: Sun Jun-ying, Professor, Doctoral supervisor, Department of Orthopedics, First Hospital Affiliated to Soochow University, Suzhou 215006, Jiangsu Province, China Sun_Junying@hotmail.com
  • About author:Liu Hong-ming★, Studying for master’s degree, Physician, Department of Orthopedics, First Hospital Affiliated to Soochow University, Suzhou 215006, Jiangsu Province, China lhmlhm-2002@163.com

PDF

594

被引次数

5

摘要：

背景：目前越来越多的高龄髋关节病变患者需要接受全髋置换治疗。但由于老年患者常存在骨质疏松，骨量易丢失，以及骨愈合能力差等问题，在施行全髋置换时，应选择何种固定类型以及何种设计的全髋股骨柄假体最为理想仍存在不同意见。
目的：观察高龄患者锥形股骨柄假体全髋置换的中期疗效。
方法：选择2002-02/2004-02苏州大学附属第一医院骨科收治的70岁以上应用锥形股骨柄假体实施全髋关节置换患者65例(70髋)，术前诊断：股骨颈骨折35例，髋关节骨关节炎10例，股骨头缺血性坏死8例，人工股骨头术后松动9例，类风湿性髋关节炎2例，先天性髋关节发育不良1例。分别于置换后1周、3，6个月随访，以后每年随访1次，对髋关节功能(Harris评分)和X射线平片进行复查。
结果与结论：6例因癌症死亡，4例死于心脑血管疾病。其余55例随访六七年，平均6.5年。末次随访髋关节Harris评分85~95分，平均90分。2髋出现轻度大腿痛，无一髋需行翻修治疗。置换后1年内X射线平片显示假体下沉小于1.5 mm者36髋。此后未再出现假体下沉。置换后3~6个月在Gruen 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Dorr C型髓腔者均无柄端周围的骨质增生或“底座征”，也无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。提示锥形股骨柄假体的锥形设计特征既可获得置入髓腔后的初始固定，又可获得由于负重行走后的假体适度下沉所产生的二次稳定，用于高龄患者生物型全髋置换中期疗效满意。

关键词: 关节置换, 高龄患者, 髋关节假体, 锥形柄, 随访

Abstract:

BACKGROUND: Increasing elderly patients with hip arthropathy require total hip replacement. However, it remains controversial on fixation type and ideal femoral shaft design due to bone mass loss and poor healing.
OBJECTIVE: To observe the mid-term effect of total hip replacement with a tapered femoral component for elderly patients.
METHODS: From February 2002 to February 2004, 65 cases (70 hips) underwent uncement total hip replacement with a tapered F2L femoral component in Department of Orthopedics, First Hospital Affiliated to Soochow University. The diagnosis included femoral neck fractures in 35 cases, osteoarthritis in 10 cases, avascular necrosis of the femoral head in 8 cases, loosening of artificial femoral head in 9 cases, rheumatoid arthritis in 2 cases, and arthrodesis in 1 case. Clinical and radiographic evaluations were performed at postoperatively 1 week, 3 and 6 months. The patients were followed up every year thereafter to recheck hip function by Harris score and X-ray.
RESULTS AND CONCLUSION: Six patients died of cancer and four died of Cardio-cerebral vascular diseases．The remaining 55 cases (60 hips) were followed up for 6-7 years, with an average follow-up of 6.5 years．At the latest follow-up, the mean Harris hip score was 90 points (85-95 scores); 2 patients (3.3%) reported mild thigh pain, but no case required revision. By the measurement of the X-ray, 36 stems had less than 1.5 mm of subsidence within the l 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 condensation and cortical hypertrophy visible around Gruen zone 6 at 3 to 6 months postoperatively, including patients of Dorr type C．Reactive 1ines covered the noncoated zone of the femoral stems for some cases. No hip had extensive proximal end osteolysis or distal intramedullary osteolysis and loosening. The patients who used tapered femoral stems which were placed in the marrow obtained the initial stability because of the design features, but also obtained the quadratic stability because walking and weight-bearing could lead to a modest subsidence of the prosthesis. Therefore, it is helpful to improve mid-term clinical results of the cementless total hip replacement for elderly patients

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