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。

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。

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%。

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。

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.

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.

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.

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.