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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 11 -18. doi: 10.3877/cma.j.issn.1674-134X.2023.01.002

临床论著

青年患者生物固定型人工全髋关节置换术后疗效评估
余新愿1, 李旭升2, 张浩强2,†(), 李梓瑶2, 周胜虎2, 乔永杰2, 甄平2, 宋晓阳1, 章文华2   
  1. 1. 730000　兰州，解放军联勤保障部队第九四〇医院骨关节外科；750000　银川，宁夏医科大学
    2. 730000　兰州，解放军联勤保障部队第九四〇医院骨关节外科
  • 收稿日期:2022-09-19 出版日期:2023-02-01
  • 通信作者: 张浩强
  • 基金资助:
    甘肃省科技计划项目(20JR5RA588); 全军后勤科研计划面上项目(CWH17J009); 兰州市人才创新创业项目(2019-RC-65); 甘肃省科技计划项目(21JR7RA014); 全军训练伤专项课题(21XLS24)

Outcome assessment of uncemented total hip replacement in young patients

Xinyuan Yu1, Xusheng Li2, Haoqiang Zhang2,†(), Ziyao Li2, Shenghu Zhou2, Yongjie Qiao2, Ping Zhen2, Xiaoyang Song1, Wenhua Zhang2   

  1. 1. Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of PLA, Lanzhou 730000, China; Department of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, China
    2. Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of PLA, Lanzhou 730000, China
  • Received:2022-09-19 Published:2023-02-01
  • Corresponding author: Haoqiang Zhang
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引用本文：

余新愿, 李旭升, 张浩强, 李梓瑶, 周胜虎, 乔永杰, 甄平, 宋晓阳, 章文华. 青年患者生物固定型人工全髋关节置换术后疗效评估[J]. 中华关节外科杂志(电子版), 2023, 17(01): 11-18.

Xinyuan Yu, Xusheng Li, Haoqiang Zhang, Ziyao Li, Shenghu Zhou, Yongjie Qiao, Ping Zhen, Xiaoyang Song, Wenhua Zhang. Outcome assessment of uncemented total hip replacement in young patients[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 11-18.

目的

评估25岁以内青年患者采用生物固定型假体行人工全髋关节置换(THA)治疗终末期髋关节疾病的临床疗效。

方法

回顾性分析2009年1月至2018年12月于联勤保障部队第九四〇医院关节外科因终末期髋关节疾病接受生物型THA治疗时年龄在25周岁及以下的患者，排除因髋部恶性肿瘤或髋关节感染接受THA治疗、随访时间小于3年、失访或资料不完整的患者。常规收集其人口学数据，采取临床评分与影像学评估相结合的方式评估患者的预后结果。临床评估：比较术前及末次随访时Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数可视化量表(WOMAC)、简明健康调查量表(SF-36)评分结果，各临床评分采用配对样本t检验，不同内衬之间评分比较采用独立样本t检验。记录患者术后并发症(如感染、翻修、脱位、切口愈合并发症等)。影像学评估：采用骨盆正位、髋关节正侧位评估假体的位置，松动、磨损、骨溶解、异位骨化及股骨填充率。THA失败定义：髋臼或股骨假体的松动或任何原因所致的翻修。

结果

共纳入患者20例(27髋)，年龄为(21.8±2.3)岁，其中男性16例(23髋)，女性4例(4髋)，13髋为左侧(48.1%)，14髋为右侧(51.9%)，7例患者行双侧THA，13例患者行单侧THA；身体质量指数(BMI)为(21.3±3.2)kg/m2；随访时间(7.8±2.4)年。随访期内一名患者因感染更换假体内衬，余患者无相关并发症发生。末次随访时Harris评分表、WOMAC评分表、SF-36生理健康评分、SF-心理健康评分较术前均有明显改善(t＝－25.31、19.47、－10.18、－7.26，均为P <0.05)。末次随访影像学结果显示假体位置较术后即时无明显改变，假体外翻角范围在32°~58°，平均(43±7)°；前倾角范围9.2°~25.6°，平均(18±4)°。无明显松动、磨损、骨溶解、异位骨化。至末次随访时，27髋总体存活率为96.3%。

结论

对于25岁以内的终末期髋关节疾病患者，行生物型THA可以较好地恢复髋关节功能且生存率高、并发症少，可以获得满意的临床疗效。

关键词: 青年人, 股骨头坏死, 关节成形术，置换, 髋, 假体和植入物
Objective

To evaluate the clinical efficacy of uncemented total hip arthroplasty (THA) in the treatment of end-stage hip disease in young patients under 25 years old.

Methods

Patients who were under 25 years of age and received uncemented THA in the Department of Orthopedics of the 940th Hospital of Joint Logistic Support Force of PLA from January 2009 to December 2018 were retrospectively analysed. The exclusion criteria were the patients who were treated with THA for hip tumour or hip infection, less than three years of follow-up, lost in follow-up or with incomplete data. The demographic data of patients were routinely collected and combinations of clinical scores and imaging assessments were used to assess outcomes of the surgery. Following clinical assessment were compared before surgery and at last follow-up after surgery: Harris hip score, Western Ontario & McMaster Universities osteoarthritis index (WOMAC) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Paired sample t test was used for clinical scores. Independent sample t test was used to compare the scores between different liners. Postoperative complications such as infection, revision, dislocation, incisional healing complications, etc. were recorded. Imaging assessment included: pelvic anteroposterior and hip anteroposterior and lateral X-rays for assessment of the position of prosthesis, prosthesis loosening and wear, osteolysis, heterotopic ossification and femoral filling rate. Loosening of acetabular or femoral component or a revision for any reason was defined as failure.

Results

A total of 20 patients (27 hips) with a mean age of (21.8±2.3) years were included. There were 16 males (23 hips) and four females (four hips) for 13 left-sided (48.1%) and 14 right-sided (51.9%) uncemented THA. Seven patients underwent bilateral THA and 13 had unilateral THA. Of all patients, the average body mass index (BMI) was (21.3±3.2) kg/m2 and the mean follow-up time was (7.8±2.4) years. During follow-up, one patient had a replacement of prosthetic liner due to infection, and the rest of patients had no THA related complication. Harris score, WOMAC score, the physical component score-SF-36 and the mental component score-SF-36 were significantly improved at the last follow-up compared with the scores before surgery (t=-25.31, 19.47, -10.18, -7.26, all P<0.05). Imaging examinations at the last follow-up showed no significant change in position of prostheses compared with the images right after the surgery, and the range of prosthetic valgus angle was 32° to 58°, at (43±7)° on average. The prosthetic anteversion angle ranged 9° to 26°, on (18±4)° on average. No loosening, wearing, osteolysis or heterotopic ossification occurred. At the final follow-up, an overall survival rate of 96.3% was achieved for the 27 hips.

Conclusion

For the patient who are under 25 years of age and with an end-stage hip disease, the uncemented THA can better restore hip functions with a high survival rate, few complication and satisfactory clinical efficacy.

Key words: Young adult, Femur head necrosis, Arthroplasty, replacement, hip, Prostheses and implants
表1 CoC及CoP界面末次随访时临床评分比较(±s)
Table 1 Comparison of clinical scores of CoC and CoP interfaces at the final follow-up
组别Group 例数Case number Harris评分Harris score WOMAC评分WOMAC score SF-36生理评分SF-36 physical score SF-36心理评分SF-36 mental score
CoC组 11 87±9 7±5 80±11 86±13
CoP组 16 89±9 8±4 82±10 80±13
t值   －0.49 －0.66 －0.48 1.06
P值   >0.05 >0.05 >0.05 >0.05
表2 临床评分比较[n＝27, (±s)]
Table 2 Comparison of clinical scores
时间点Time Harris评分Harris score WOMAC评分WOMAC score SF-36生理评分SF-36 physical score SF-36心理评分SF-36 mental score
术前Pre-operation 43±14 43±8 48±9 56±13
末次随访时Last follow-up 88±9 11±7 81±10 83±13
t值 －25.31 19.47 －10.18 －7.26
P值 <0.05 <0.05 <0.05 <0.05
图1 典型病例1术前及术后影像学资料。图A术前骨盆正位X线片示双侧股骨头坏死；图B骨盆正位X线片示双侧股骨头钻孔减压术后改变；图C~F患者行双侧人工全髋关节术后骨盆正位及髋关节正侧位X线片，示假体位置良好，股骨假体与骨髓腔匹配良好；图G为最新随访时骨盆正位X线片，示双侧假体位置良好，股骨假体与髓腔匹配良好，无松动下沉表现
Figure 1 Preoperative and postoperative imaging of case one. A is preoperative X-ray of anteroposterior view of pelvis showing bilateral femoral head necrosis；B is intraoperative X-ray of anteroposterior view of pelvis showing changes after bilateral femoral head drilling and decompression；C to F are X-rays after bilateral total hip arthroplasty(anteroposterior view of pelvis and anteroposterior and lateral views of hip) showing good prosthesis position and good match between the femoral prosthesis and the bone marrow cavity；G is X-ray of anteroposterior view of pelvis at the final follow-up showing good prosthesis position bilaterally and good match between femoral prosthesis, bone marrow cavity without sign of loosening and sinking
图2 典型病例2术前及术后影像学资料。图A术前骨盆正位X线片示左侧股骨头坏死并半脱位；图B患者术后即刻髋关节正侧位X线片，示左侧股骨头旋转中心下移，假体位置良好，股骨假体与骨髓腔匹配良好；图C最新随访时患者骨盆正位X线片，示假体位置良好，股骨假体与髓腔匹配良好，无松动下沉表现
Figure 2 Preoperative and postoperative imaging of case two. A is preoperative X-ray of anteroposterior view of pelvis showing left femoral head necrosis and subluxation；B are X-rays of anteroposterior view of pelvis and anteroposterior and lateral views of hip immediately after surgery, showing centre of rotation of left femoral head shifted downwards, the prosthesis in good position and femoral prosthesis matched well with bone marrow cavity；C is X-ray of anteroposterior view of pelvis at the final follow-up, showing prosthesis in good position, femoral prosthesis matched well with bone marrow cavity and no sign of loosening and sinking
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