非骨水泥全髋关节置换术治疗肾移植术后股骨头坏死的短期疗效

摘要

目的 探讨非骨水泥全髋关节置换术(total hip replacement,THR)治疗肾移植术后股骨头坏死(osteonecrosis of the femoral head,ONFH)的短期疗效.方法 回顾性总结非骨水泥THR治疗肾移植术后ONFH患者17例(22髋),男11例,女6例;平均年龄38.4岁(25～64岁).ONFH按ARCO标准分期,Ⅱ C期1例(1髋),ⅢB期2例(3髋),ⅢC期4例(5髋),Ⅳ期10例(13髋).除4例患者THR术前1～5个月停用激素外,其他患者围于术期和术后均维持使用免疫抑制剂.肾移植术前接受血液透析时间平均为16个月(0～87个月),肾移植术至接受THR的平均时间为3.4年(1.5～6年).全部采用非骨水泥THR,Versys股骨假体和Trilogy髋臼假体各5髋,Zweymuller股骨假体和EP-FIT髋臼假体各17髋;金属头对聚乙烯臼13髋,陶瓷头对陶瓷臼9髋.结果 17例患者全部获得随访,平均随访2.3年(11个月～5.1年).Harris评分为优15髋(68.2%),良7髋(31.8%);从术前平均(41.3±6.4)分提高到术后平均(92.2±7.1)分.术后并发症有切口浅表感染1例,下肢深静脉血栓1例,异位骨化1例,假体不稳定1例.结论 非骨水泥THR治疗肾移植术后ONFH可获得满意的短期疗效,长期应用激素和免疫抑制剂并不影响假体的早期稳定性,但中远期疗效有待进一步观察.%Objective To study the short-term outcomes of uncemented total hip replacement(THR) performed for osteonecrosis of the femoral head (ONFH) after renal transplantation.Methods Seventy patients (20 hips) with ONFH after renal transplantation were treated with uncemented THR from May 2002 to August 2007.There were 11 males and 6 female with the mean age of 38.4 years (range, 25-64 years).According to ARCO classification, there were type Ⅱ C in 1 case(l hip), type ⅢB in 2 cases(3 hips), type Ⅲ C in 4 cases(5 hips), type Ⅳ in 10 cases( 13 hips).Except 4 patients stopped using steroids before THR 1-5 months, the others were treated with steroids and immunosuppressants during perioperation and postopera-tion.The mean time of hemodialysis before transplantation in all cases was 16 months (range 0-87 months).And the mean time from onset of dialysis to arthroplasty was 3.4 years (range 1.5-6 years).All implants were imported prothesis, Zimmer Versys 5 hips and Plus Zweymuller 17 hips, metal to polyethylene 13 hips and ceramic to ceramic 9 hips.Results The mean follow-up was 2.3 years (11 months to 5.1 years).At the time of the last follow-up, 22 hips were rated as excellent in 15 hips (68%) and good in 7 hips (31.8%).The Harris score increased to 92.2 from 41.3 preoperatively.The other complications included infection of incision in 1 case, deep venous thrombosis in 1 case, heterotopic ossification in 1 case, and prosthesis loosening in 1 case.Conclusion The early outcomes of uncemented THR performed after renal transplantation are satisfactory.The use of steroids and immunosuppressants has no influence on early stability of prostheses, however the middle-term and the long-term outcomes need to be confirmed in our future follow-up.