D'Ambrosi Riccardo, Marciandi Luca, Frediani Piero Vittorio, Facchini Renato Mario
Università degli Studi di Milano, Italy; Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milano, Italy.
A.O.S. Antonio Abate, U.O. di Ortopedia e Traumatologia, Gallarate, Varese, Italy.
J Orthop Sci. 2016 Jul;21(4):500-506. doi: 10.1016/j.jos.2016.03.009. Epub 2016 Apr 10.
Several diseases may lead to advanced hip disease and cause disabling symptoms in adolescents. In literature there is no consensus which is the optimal surgical treatment for young adults with end-stage osteoarthritis. The purpose of this study was to assess the clinical and radiological outcomes of uncemented total hip arthroplasty for the treatment of end-stage hip arthritis in patients younger than 20 years at a minimum follow-up of ten years.
We have retrospectively evaluated 24 patients who were 20 years or younger and underwent uncemented total hip arthroplasty. Minimum follow-up was 10 years. Clinical outcome was measured using the Harris Hip Score, Western Ontario McMaster, and the Short-Form 36. Hip calcification was evaluated using Brooker classification, while osteolysis was examined at the final follow-up according to the subdivision of Gruen.
The mean preoperative Harris Hip Score was 36.94 points and improved to 92.3, and the mean preoperative WOMAC score improved from 84.72 to 28.45 The Mental Component score-SF-36 improved from a preoperative mean of 26.23 points to 58.96, while the Physical Component score-SF-36 improved from a preoperative mean of 26.38-49.95. All components were stable and osseo-integrated. Radiolucent lines were not present in any hips. We noted the presence of 4 calcifications. No patient needed implant revision. The only complication was an intraoperative femoral fracture.
Total hip arthroplasty is a safe and reliable procedure for the treatment of end-stage arthritis in the young that provides good to excellent mid-term results.
多种疾病可能导致青少年晚期髋关节疾病并引发致残症状。在文献中，对于终末期骨关节炎的年轻成年人，哪种手术治疗方法最为理想尚无共识。本研究的目的是评估在至少十年的随访期内，非骨水泥型全髋关节置换术治疗20岁以下终末期髋关节关节炎患者的临床和放射学结果。
我们回顾性评估了24例年龄在20岁及以下且接受非骨水泥型全髋关节置换术的患者。最短随访期为10年。使用Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及简明健康状况调查问卷（SF-36）来衡量临床结果。使用布鲁克分类法评估髋关节钙化情况，而根据Gruen分区在最终随访时检查骨溶解情况。
术前Harris髋关节评分平均为36.94分，术后提高到92.3分；术前WOMAC评分平均从84.72分提高到28.45分。SF-36的心理成分评分从术前平均26.23分提高到58.96分，而SF-36的身体成分评分从术前平均26.38分提高到49.95分。所有组件均稳定且骨整合良好。所有髋关节均未出现透光线。我们注意到有4处钙化。没有患者需要进行植入物翻修。唯一的并发症是术中股骨骨折。
全髋关节置换术是治疗年轻患者终末期关节炎的一种安全可靠的手术方法，可提供良好至优异的中期结果。
