Bessette Benoît J, Fassier François, Tanzer Michael, Brooks Caleb E
Department of Surgery, Division of Orthopedic Surgery, McGill University Health Centre, Montréal, Que.
Can J Surg. 2003 Aug;46(4):257-62.
To evaluate the function, radiographic results and implant survival in patients younger than 21 years at the time of operation and with at least a 10-year follow-up, we reviewed the course of young adults who underwent total hip arthroplasty at McGill University Health Centre.
Twelve patients (16 hips) met the criteria for inclusion in this study. They ranged in age from 10-20 years (median 16.5 yr). One patient (1 hip) died 5 years after the index surgery and was excluded from the study. Functional results were measured by the Harris hip score, and radiographs of surviving implants were assessed for radiolucencies, osteolysis and eccentric polyethylene wear.
Eleven arthroplasties were cementless, 2 were hybrid and 2 were cemented. At follow-up ranging from 10 to 25 years (mean 13.6 yr), the Harris hip score ranged from 34.2-97.2 (mean 64.5). Four (26%) acetabular components were revised and (at the time of writing) 1 required revision. Only 1 (7%) femoral stem was revised. Radiographically, there was a high prevalence of eccentric polyethylene wear, but none of the surviving implants were found to be loose. Overall, 67% (10 of 15) of the total hip arthroplasties continued to function well at a mean of 13.6 years postoperatively.
Total hip arthroplasty remains a reasonable option in adolescence and early adulthood in selected patients with severe debility from multiple joint disease. Polyethylene wear is a particularly significant problem in this group of active young people.
为了评估手术时年龄小于21岁且至少随访10年的患者的功能、影像学结果及植入物生存率，我们回顾了在麦吉尔大学健康中心接受全髋关节置换术的年轻成年人的病程。
12名患者（16髋）符合本研究的纳入标准。他们的年龄在10至20岁之间（中位数16.5岁）。1名患者（1髋）在初次手术后5年死亡，被排除在研究之外。通过Harris髋关节评分评估功能结果，并对存活植入物的X线片进行评估，以检测透亮区、骨溶解和偏心聚乙烯磨损情况。
11例关节置换为非骨水泥型，2例为混合型，2例为骨水泥型。在10至25年（平均13.6年）的随访中，Harris髋关节评分范围为34.2至97.2（平均64.5）。4例（26%）髋臼组件进行了翻修，（在撰写本文时）1例需要翻修。仅1例（7%）股骨干进行了翻修。影像学检查显示，偏心聚乙烯磨损的发生率较高，但未发现存活的植入物有松动。总体而言，67%（15例中的10例）的全髋关节置换术在术后平均13.6年时仍功能良好。
对于因多关节疾病导致严重残疾的特定患者，全髋关节置换术在青少年和青年早期仍是一种合理的选择。聚乙烯磨损在这群活跃的年轻人中是一个特别重要的问题。
