Carrothers Andrew D, Gilbert Robin E, Richardson James B
Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry - UK.
Hip Int. 2011 Mar-Apr;21(2):217-24. doi: 10.5301/HIP.2011.6500. Epub 2011 Mar 31.
There is no published literature to support mid to long term results of hip resurfacing (HR) arthroplasty in patients over the age of 70 years. The purpose of our study was to evaluate the function HR in this age group (70 or older at the time of surgery) at medium to long term follow-up. Between July 1997 and November 2002, the Oswestry Outcome Centre independently and prospectively collected data on 5000 Birmingham Hip Resurfacings (BHRs). 106 had been implanted in elderly patients who were 70 years of age or older. The post-operative Harris and Merle D'Aubigné and Postel (MDP) hip scores and causes for revision were used to ascertain function and implant survival. Hip scores for the older BHR patients were compared with those from younger patients. The average age at surgery of the elderly BHR cohort was 73.2 years (range, 70.0 to 87.9 years) with a mean follow-up of 7.1 years (range, 0.5 to 10.9 years). Four patients had a femoral neck fracture and required conversion to a conventional total hip replacement. There were no patients lost to follow-up and no dislocations in this series. The median Harris hip score (HHS) was significantly better in the younger BHR group compared with the elderly BHR group, (96 vs. 94 p=0.008). There was no significant difference in recovery rates after surgery. There was a significantly higher rate of revision in women than men among the elderly patients (male= 1 of 65 (1.5%); women = 3 of 19 (15.8%), p=0.03). At latest follow-up the elderly patients continued to function well when compared with the younger BHR patients. There was a high mid to long term success rate after HR in patients who were 70 years of age or older, without the failure burden possibly anticipated. Elderly patients had a poorer functional outcome, but a difference in HHS of two points may be of only minor clinical significance.
目前尚无已发表的文献支持70岁以上患者接受髋关节表面置换（HR）手术的中长期疗效。我们研究的目的是在中长期随访中评估该年龄组（手术时年龄70岁及以上）髋关节表面置换术的功能。1997年7月至2002年11月期间，奥斯沃斯特里结果中心独立且前瞻性地收集了5000例伯明翰髋关节表面置换术（BHR）的数据。其中106例植入了70岁及以上的老年患者体内。采用术后哈里斯评分以及Merle D'Aubigné和Postel（MDP）髋关节评分和翻修原因来确定功能和植入物生存率。将老年BHR患者的髋关节评分与年轻患者的评分进行比较。老年BHR队列的平均手术年龄为73.2岁（范围为70.0至87.9岁），平均随访时间为7.1年（范围为0.5至10.9年）。4例患者发生股骨颈骨折，需要转换为传统全髋关节置换术。该系列中无失访患者，也无脱位病例。年轻BHR组的哈里斯髋关节评分（HHS）中位数明显优于老年BHR组（96对94，p = 0.008）。术后恢复率无显著差异。老年患者中女性的翻修率明显高于男性（男性 = 65例中的1例（1.5%）；女性 = 19例中的3例（15.8%），p = 0.03）。在最新随访时，与年轻BHR患者相比，老年患者的功能仍然良好。70岁及以上患者接受髋关节表面置换术后中长期成功率较高，没有出现可能预期的失败负担。老年患者的功能结局较差，但HHS相差2分可能仅具有较小的临床意义。
