Cebesoy Oğuz, Erdemli Bülent, Köse Kamil Cağri, Güzel Bahaddin, Cetin Ilker
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Gaziantep University, Gaziantep, Turkey.
Acta Orthop Traumatol Turc. 2006;40(4):301-6.
We evaluated the midterm results of total hip arthroplasty (THA) for femoral neck osteonecrosis.
The study included 59 patients (23 females, 36 males; mean age 45.6 years; range 24 to 66 years) who underwent THA in 72 hips. Osteonecrosis was secondary to fracture in the femoral neck in 11 hips (15.3%), was associated with steroid use in 23 hips (31.9%), and was idiopathic in 38 hips (52.8%). Functional evaluations were made with the hip scoring system of D'Aubigne and Postel. Bone-implant relations were assessed radiographically using the Gruen's seven zones in the femur and Charnley's three zones in the acetabulum. The mean follow-up was 4.1 years (range 2 to 7 years).
The mean D'Aubigne-Postel hip score was 11.8 (range 7 to 16), with good or excellent results in all hips. While no significant difference was found between cementless and hybrid systems (p>0.05), the mean hip score was significantly higher with press-fit acetabular systems compared to expansion cups (p<0.001). The effects of the following were found insignificant on the clinical outcome (p>0.05): etiology, metal-on-metal or metal-on-polyethylene surfaces, and development of stress shielding in the proximal femur or of varus-valgus angulation in the femoral stem. However, the results were significantly less favorable in cases in which complications arose (p<0.001). Intraoperative complications were fissure in five patients and isolated trochanteric fracture in five patients, all of which occurred in cementless THA. Heterotopic ossification was seen in six hips. At the end of 6.5 years, mild polyethylene wear was detected in eight hips, two of which also had focal osteolysis in Gruen zone 1.
Thanks to improvements in implant technology and surgical techniques, the results of both cementless and hybrid systems are satisfactory in hip osteonecrosis, regardless of the etiology.
我们评估了全髋关节置换术（THA）治疗股骨颈骨坏死的中期结果。
该研究纳入了59例患者（23例女性，36例男性；平均年龄45.6岁；范围24至66岁），共72髋接受了THA。11髋（15.3%）骨坏死继发于股骨颈骨折，23髋（31.9%）与使用类固醇有关，38髋（52.8%）为特发性。采用D'Aubigne和Postel髋关节评分系统进行功能评估。使用股骨的Gruen七区和髋臼的Charnley三区进行影像学评估骨与植入物的关系。平均随访时间为4.1年（范围2至7年）。
D'Aubigne - Postel髋关节平均评分为11.8（范围7至16），所有髋关节结果均为良好或优秀。虽然非骨水泥型和混合型系统之间未发现显著差异（p>0.05），但与扩张髋臼杯相比，压配式髋臼系统的平均髋关节评分显著更高（p<0.001）。发现以下因素对临床结果无显著影响（p>0.05）：病因、金属对金属或金属对聚乙烯表面，以及股骨近端应力遮挡或股骨干内翻 - 外翻成角的发展。然而，出现并发症的病例结果明显较差（p<0.001）。术中并发症包括5例患者出现裂缝和5例患者出现孤立性转子骨折，均发生在非骨水泥型THA中。6髋出现异位骨化。在6.5年时，8髋检测到轻度聚乙烯磨损，其中2髋在Gruen 1区也有局灶性骨溶解。
由于植入技术和手术技术的改进，无论病因如何，非骨水泥型和混合型系统在髋关节骨坏死中的结果均令人满意。
