小尺寸股骨头坏死的髋关节表面置换术：73例患者的中位随访8年
Hip resurfacing for small-sized osteonecrosis: 73 cases at a median 8years' follow-up.
作者信息
Martinot Pierre, Martin Théo, Dartus Julien, Cailliau Emeline, Putman Sophie, Migaud Henri, Girard Julien
机构信息
Université Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France.
Université Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France.
出版信息
Orthop Traumatol Surg Res. 2023 Feb;109(1):103471. doi: 10.1016/j.otsr.2022.103471. Epub 2022 Nov 3.
INTRODUCTION
Total hip resurfacing arthroplasty (THRA) is an alternative to conventional total hip replacement (THR) in young patients with osteonecrosis of the femoral head. Series have been small, without criteria regarding extent of necrosis, thus vitiating results. We therefore conducted a retrospective assessment of THRA for small necrosis, to determine (1) implant survival, (2) functional scores, and (3) systemic chromium, cobalt and titanium ion concentrations.
HYPOTHESIS
The study hypothesis was that the revision rate is low, meeting the National Institute for Health and Care Excellence (NICE) criterion of<0.5% revision per year.
MATERIAL AND METHOD
A single-center single-surgeon retrospective study included 62 patients, for 73 RTHAs, with a mean age of 45.6years (range: 23-68years) presenting Ficat stage 3 or 4 osteonecrosis of the femoral head with<330° total Kerboul angle (frontal+lateral angles) on simple preoperative X-ray. Study data comprised implant survival and preoperative and last follow-up functional scores (Postel-Merle-d'Aubigné, Oxford-12, Harris, and Devane) and titanium, chromium and cobalt blood concentrations. Necrosis size was assessed on preoperative Kerboul angle.
RESULTS
At a median 8years' follow-up (IQR: 5.9-9.3years), implant survival was 98.6% (95% CI: 97.22-99.98%). Only 1 implant was exchanged, for femoral loosening. Three other patients underwent revision surgery: 2 cases of lavage for infection, and 1 muscle hernia repair. Postel-Merle-d'Aubigné, Oxford-12 and Harris functional scores and Devane activity scores were significantly improved at follow-up, by a median +5 (IQR: 5 to 7), -26 (IQR: -29 to -23), +55 (IQR: 49 to 61) and +1 (IQR: 1 to 2), respectively (all p<0.001). Ion concentrations at last follow-up for titanium, chromium and cobalt were respectively 4.0μg/L (range: 3.6-4.1), 1.1μg/L (range: 0.8-1.9) and 1.1μg/L (range: 0.6-1.8).
CONCLUSION
THRA is a useful option in the long-term for young patients with osteonecrosis with Kerboul angle<330°.
LEVEL OF EVIDENCE
IV, retrospective study.
引言
对于股骨头坏死的年轻患者，全髋关节表面置换术（THRA）是传统全髋关节置换术（THR）的一种替代方案。相关病例系列规模较小，且未对坏死范围制定标准，因此影响了研究结果。我们因此对小范围坏死的全髋关节表面置换术进行了回顾性评估，以确定：（1）植入物生存率；（2）功能评分；（3）全身铬、钴和钛离子浓度。
假设
研究假设为翻修率较低，符合英国国家卫生与临床优化研究所（NICE）每年翻修率<0.5%的标准。
材料与方法
一项单中心单术者的回顾性研究纳入了62例患者的73次全髋关节表面置换术，患者平均年龄45.6岁（范围：23 - 68岁），术前简单X线显示为Ficat 3期或4期股骨头坏死，总Kerboul角（前倾角 + 侧倾角）<330°。研究数据包括植入物生存率、术前及末次随访时的功能评分（Postel-Merle-d'Aubigné评分、牛津12项评分、Harris评分和Devane评分）以及钛、铬和钴的血药浓度。根据术前Kerboul角评估坏死大小。
结果
中位随访8年（四分位间距：5.9 - 9.3年）时，植入物生存率为98.6%（95%置信区间：97.22 - 99.98%）。仅1枚植入物因股骨松动而更换。另外3例患者接受了翻修手术：2例因感染行冲洗术，1例因肌肉疝修补。随访时，Postel-Merle-d'Aubigné评分、牛津12项评分、Harris功能评分和Devane活动评分均显著改善，中位改善值分别为 +5（四分位间距：5至7）、 -26（四分位间距： -29至 -23）、 +55（四分位间距：49至61）和 +1（四分位间距：1至2）（均p<0.001）。末次随访时钛、铬和钴的离子浓度分别为4.0μg/L（范围：3.6 - 4.1）、1.1μg/L（范围：0.8 - 1.9）和1.1μg/L（范围：0.6 - 1.8）。
结论
对于Kerboul角<330°的股骨头坏死年轻患者，全髋关节表面置换术是一种长期有效的选择。
证据级别
IV级，回顾性研究。
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