[对156个骨水泥固定的抛光铝/聚乙烯合金全髋关节假体队列进行的10年精算分析]

Le Mouel S, Allain J, Goutallier D

Service de Chirurgie Orthopédique, Hôpital Henri Mondor, Créteil.

Rev Chir Orthop Reparatrice Appar Mot. 1998 Jul;84(4):338-45.

PURPOSE OF THE STUDY

From 1983 to 1986, 156 alumina/polyethylene combination hip arthroplasties (131 patients) were performed at the Henri Mondor Hospital. Before 1983, the stainless-steel/polyethylene combination was performed. In this follow-up study, the outcome of the first 156 consecutive alumine-polyethylene combination hip arthroplasties were analyzed with clinical and radiological features. The comparison of the two combinations was analyzed. A survival analysis was performed over a ten years interval.

MATERIAL AND METHODS

The femoral component of the prosthesis was made of Titanium alloy (TiA16V4). The femoral head was made of dense alumina (A1203). The head diameter was 32 mm. The socket was made of ultra-high-molecular-weight polyethylene (UHMWPE). Fixation of head to stem was obtained through conical sleeving. We used a posterolateral approach, and a cemented THA without pressurization. At last follow-up evaluation, 90 patients were reviewed, 9 patients were interviewed by phone. Three patients were dead and 20 patients were lost for follow-up evaluation, in the first year. Nine failures were reoperated. The major cause of failure was septic complication of the THA (8). The average age of patients at arthroplasty was 58.1 year. The clinical evaluation was performed with the Merle d'Aubigné, Postel scoring system. The radiographs of 117 hips out of the 156 were available for this evaluation. Radiolucents, failures and wear were analyzed.

RESULTS

There was a 5 per cent rate (8 hips) of deep infection due for two hips to the underlying pathology. Ten (6.5 per cent) of the 156 hips had had an episode of dislocation at last follow-up. Eighty-nine per cent of the hips were rated excellent, very good, and good; 9.3 per cent were rated fair: and 1.7 per cent were rated poor. The radiographs of the socket revealed 54 per cent of bone-cement radiolucent and three failures at last follow-up. The radiographs of the stem revealed 29 per cent of bone-cement radiolucent and one failure at last follow-up. There was no revision of the femoral stem. Survival analysis (aseptic failures) depicted 93.45 per cent durability of the arthroplasty at 10 years. The survival analysis for the socket alone, using the same criteria for failure, demonstrated 94.53 per cent survival success at 10 years, and 98.91 per cent for the stem component. The comparison of the two combinations gave us a survival analysis for the socket alone, using aseptic failure as criteria, 79.84 per cent for stainless-steel/polyethylene combination at 8 years, and 97.63 per cent for alumina/polyethylene at the same time.

CONCLUSION

The alumina/polyethylene combination with a 32 mm head diameter gave better results than the stainless-steel/polyethylene combinations. The improvement was noted on the acetabular component.

研究目的

1983年至1986年期间，亨利·蒙多医院共进行了156例氧化铝/聚乙烯组合髋关节置换术（涉及131名患者）。1983年之前则采用不锈钢/聚乙烯组合。在这项随访研究中，对首批连续的156例氧化铝 - 聚乙烯组合髋关节置换术的结果进行了临床和放射学特征分析。对两种组合进行了比较，并进行了为期十年的生存分析。

材料与方法

假体的股骨部件由钛合金（TiA16V4）制成。股骨头由致密氧化铝（A1203）制成。头部直径为32毫米。髋臼杯由超高分子量聚乙烯（UHMWPE）制成。通过锥形套管实现头部与柄的固定。我们采用后外侧入路，进行非加压骨水泥型全髋关节置换术。在最后一次随访评估时，对90名患者进行了复查，9名患者通过电话进行了访谈。第一年有3名患者死亡，20名患者失访。9例失败病例进行了再次手术。失败的主要原因是全髋关节置换术的感染并发症（8例）。患者进行关节置换术时的平均年龄为58.1岁。采用Merle d'Aubigné、Postel评分系统进行临床评估。156例中有117例髋关节的X线片可用于此次评估。分析了透亮区、失败情况和磨损情况。

结果

因潜在病理原因导致2例髋关节深部感染，感染率为5%（8例髋关节）。156例髋关节中有10例（6.5%）在最后一次随访时发生过脱位。89%的髋关节评定为优、良或中；9.3%评定为差；1.7%评定为劣。髋臼杯的X线片显示，最后一次随访时54%存在骨水泥透亮区，3例失败。股骨柄的X线片显示，最后一次随访时29%存在骨水泥透亮区，1例失败。股骨柄未进行翻修。生存分析（无菌性失败）显示，关节置换术在10年时的耐用率为93.45%。仅对髋臼杯进行生存分析，采用相同的失败标准，显示10年时生存率为94.53%，股骨柄部件为98.91%。两种组合的比较显示，仅对髋臼杯进行生存分析，以无菌性失败为标准，不锈钢/聚乙烯组合在8年时为79.84%，同期氧化铝/聚乙烯组合为97.63%。