Chan Y S, Shih C H
Department of Orthopaedic Surgery, Chang Gung University Hospital, Taoyuan, Taiwan.
Clin Orthop Relat Res. 2000 Oct(379):169-77. doi: 10.1097/00003086-200010000-00020.
The authors studied 28 patients with bilateral avascular necrosis of the femoral head who were treated with a cementless bipolar endoprosthesis in one hip and cementless total hip arthroplasty in the other. All the hips selected for bipolar endoprostheses were classified as having avascular necrosis of the femoral head Ficat Stage III, and all the hips selected for total hip arthroplasty were classified as having Ficat Stage IV avascular necrosis. After a midterm followup of an average of 6.4 years (range, 4-12 years), 24 of 28 hips that received bipolar endoprostheses were considered satisfactory, whereas 23 of 28 hips in which an arthroplasty was done were considered satisfactory. After a followup of more than 6 years, the cartilaginous space of the acetabulum could be preserved in 25 hips (89.3%) that received a bipolar endoprosthesis. There were no statistical differences in both groups in terms of clinical result, thigh pain, groin pain, osteolysis, dislocation, and revision rate. Total hip arthroplasty is not the preferred treatment for all patients with hip osteonecrosis. In young patients with Ficat Stage III osteonecrosis with Grade 0 or Grade I cartilage, the use of a cementless bipolar endoprosthesis with a bone ingrowth stem may be considered as an alternative to total hip arthroplasty.
作者研究了28例双侧股骨头缺血性坏死患者，其中一侧髋关节采用非骨水泥型双极人工关节置换，另一侧采用非骨水泥型全髋关节置换。所有选择双极人工关节的髋关节均被分类为股骨头缺血性坏死Ficat III期，所有选择全髋关节置换的髋关节均被分类为Ficat IV期缺血性坏死。经过平均6.4年（范围4 - 12年）的中期随访，28例接受双极人工关节置换的髋关节中有24例被认为效果满意，而28例接受关节置换的髋关节中有23例被认为效果满意。经过6年以上的随访，接受双极人工关节置换的25例髋关节（89.3%）髋臼软骨间隙得以保留。两组在临床结果、大腿疼痛、腹股沟疼痛、骨质溶解、脱位和翻修率方面均无统计学差异。全髋关节置换并非所有髋部骨坏死患者的首选治疗方法。对于Ficat III期骨坏死且软骨为0级或I级的年轻患者，可考虑使用带骨长入柄的非骨水泥型双极人工关节作为全髋关节置换的替代方案。
