全髋关节置换术中使用陶瓷轴承的 10 年生存率较高。
Ceramic bearings for total hip arthroplasty have high survivorship at 10 years.
机构信息
Greater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108, USA.
出版信息
Clin Orthop Relat Res. 2012 Feb;470(2):373-81. doi: 10.1007/s11999-011-2076-7.
BACKGROUND
Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings.
QUESTIONS/PURPOSES: We asked whether ceramic bearings have equal or superior survivorship compared with that for metal-on-polyethylene at longer followup; we also determined survivorship of the implant systems, the presence or absence of radiographic osteolysis, and incidence of device squeaking.
METHODS
Five surgeons at five sites have followed 189 patients (216 hips) for a minimum of 10 years and average of 10.3 years (range, 10-12.4 years) comparing alumina ceramic bearings (144 hips) with cobalt chrome-on-polyethylene bearings (72 hips). We determined Kaplan-Meier survivorship of the bearing surface and implant systems and collected radiographic and clinical data.
RESULTS
We observed no difference between the control metal-on-polyethylene and the alumina-bearing couple cohorts with regard to bearing-related failures (98.9% versus 99.1%). Revisions for any reason occurred in 10.5% of the control patients and 3.1% of the patients with alumina bearings. All femoral implants remain well fixed (100%), whereas one acetabular component (1%) is unstable in the control group. Osteolysis occurred in 26% of the control patients and in none of the patients with alumina bearings. Squeaking occurred in two of 144 hips (1.4%) of the patients with ceramic bearings.
CONCLUSIONS
Patients receiving the ceramic-on-ceramic bearings had fewer revisions for any reason and less osteolysis than the control metal-on-polyethylene at 10 years. Our data suggest ceramic bearings continue to provide an option for the young and more active patient and provide for a measure to compare other new alternative bearings that are currently available.
LEVEL OF EVIDENCE
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
陶瓷轴承的引入是为了减少磨损并提高全髋关节置换术的长期存活率。在之前一项比较陶瓷与金属-聚乙烯在 5 至 8 年的研究中，我们发现陶瓷轴承具有更高的存活率，且不存在骨溶解。
问题/目的：我们想知道在更长的随访时间内，陶瓷轴承的存活率是否与金属-聚乙烯相当或更高；我们还确定了植入物系统的存活率、是否存在放射影像学骨溶解以及器械吱吱声的发生率。
方法
五位医生在五个地点对 189 名患者（216 髋）进行了随访，随访时间至少为 10 年，平均 10.3 年（范围为 10-12.4 年），比较了氧化铝陶瓷轴承（144 髋）和钴铬-聚乙烯轴承（72 髋）。我们使用 Kaplan-Meier 法评估了轴承表面和植入物系统的存活率，并收集了放射影像学和临床数据。
结果
在与轴承相关的失败方面，我们观察到对照组金属-聚乙烯和氧化铝轴承组之间没有差异（98.9%对 99.1%）。对照组中有 10.5%的患者和氧化铝组中有 3.1%的患者因任何原因接受了翻修。所有股骨植入物均固定良好（100%），而对照组中有一个髋臼部件（1%）不稳定。对照组中有 26%的患者发生骨溶解，而氧化铝组中无一例发生。在使用陶瓷轴承的 144 髋中，有两髋（1.4%）出现了吱吱声。
结论
在 10 年时，接受陶瓷-陶瓷轴承的患者因任何原因接受翻修的次数更少，且骨溶解的发生率也低于对照组的金属-聚乙烯。我们的数据表明，陶瓷轴承继续为年轻且活动较多的患者提供了一种选择，并为比较目前可用的其他新型替代轴承提供了一种衡量标准。
证据水平
I 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
Zotero 插件