第四代陶瓷假体人工全髋关节置换短期临床疗效随访研究

发布时间：2018-08-23 08:39

【摘要】：目的通过对应用第四代陶瓷假体行人工全髋关节置换术的患者的短期随访研究，以评价其短期临床效果。方法 2011年11月-2014年6月，于我院住院手术治疗、经影像学检查确诊的76例懫用第四代陶瓷全髋关节假体患者，排除失访8例后剩余68例，资料完整。其中男39例，女29例，年龄22-63岁，平均年龄42.5岁，共92髋（双髓24例，单髋44例）。所有患者均行全髋关节置换术，均采用第四代陶瓷全髋关节假体，46例髋应用的为大直径陶瓷头假体组合。所有病例为初次全髋关节置换，其中部分患者（6例）分期行双侧全髋置换术。术前对所有患者进行双髋关节常规查体、影像学检查，Hariss评分（表一术后随访了解患者髋关节的活动度、术后lianss评分、并发症及患者满意度等情况，并对比患者末次术影像学检查，结合Greun股骨分区和Delee-Chanley髋臼侧分区进行影像学评估，，异位骨化采用Brooker分级法分级。结果 68例患者均获得随访，随访6-36个月不等，平均21个月。术前hariss评分为18-52分，平均35分，术后末次随访hariss评分为95-98分，平均96.5分，术前与术后末次随访liariss评分比较有统计学意义（p0.05)。所有病人术中、术后均无血管神经损伤、血栓栓塞、感染、假体脱位、假体周围骨折及明显下肢短缩，末次X线检查均显示假体位置固定良好，无明显透亮线、骨溶解、异位骨化及假体松动、假体碎裂等征象。其中1例出现术后髋关节异响，未做任何处置，术后1年左右异响消失。通过术前术后Harris评分、术后疼痛持续时间、并发症、满意度及影像学对比，治疗效果优良率98.53%，术后髋关节功能获得极大提高。结论第四代陶瓷假体有着良好的短期临床疗效，是由其超高的硬度、韧度、耐磨性及稳定性所决定，其中，许多研究认为应用大直径陶瓷股骨头假体效果更佳，其优点有极低的关节脱位率，更大度数的髋关节活动度，以及本体感觉可能性提高等，患者术后的生活质量得到了显著改善，也为年轻、活动量大的患者提供了一种较为理想的假体类型。异响发生率为1.09%，其机制有待进一步研究。
[Abstract]:Objective to evaluate the short-term clinical effect of total hip arthroplasty with fourth generation ceramic prosthesis. Methods from November 2011 to June 2014, 76 patients with fourth generation ceramic total hip prosthesis were treated by surgery in our hospital from November 2011 to June 2014. The data of the remaining 68 cases were complete after 8 cases were excluded. There were 39 males and 29 females, aged 22-63 years, with an average age of 42.5 years. There were 92 hips (24 cases with double medulla and 44 cases with single hip). All the patients underwent total hip replacement. The fourth generation ceramic total hip prosthesis was used in 46 cases with large diameter ceramic head prosthesis. All cases were treated with primary total hip replacement, and some patients (6 cases) underwent bilateral total hip replacement by stages. All the patients were examined by routine hip joint examination before operation, and by imaging examination and Hariss score (Table 1, follow up after operation to find out the hip motion, postoperative lianss score, complications and patient satisfaction, etc.) Compared with the imaging examination of the last operation, combined with Greun femur division and Delee-Chanley acetabular lateral division, the ectopic ossification was graded by Brooker classification. Results 68 patients were followed up for 6-36 months with an average of 21 months. The preoperative hariss score was 18-52 points (mean 35 points) and the last follow-up hariss score was 95-98 points (average 96.5 points). There was significant difference in liariss score between preoperative and postoperative follow-up (p0.05). No vascularized nerve injury, thromboembolism, infection, prosthesis dislocation, periprosthetic fracture and lower extremity shortening were found in all patients. Ectopic ossification and loose prosthesis, prosthesis fragmentation and other signs. In one case, the abnormal sound of hip joint disappeared about 1 year after operation without any treatment. Through preoperative and postoperative Harris score, postoperative pain duration, complications, satisfaction and imaging comparison, the excellent and good rate of treatment was 98.53, postoperative hip joint function was greatly improved. Conclusion the fourth generation ceramic prosthesis has a good short-term clinical effect, which is determined by its high hardness, toughness, wear resistance and stability. It has the advantages of extremely low dislocation rate, greater hip motion, and increased proprioceptive possibility. The quality of life of the patients after operation has been significantly improved, and it is also young. Patients with high levels of activity provide an ideal type of prosthesis. The incidence of abnormal noise was 1.09, and its mechanism needs further study.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.42

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