不同直径股骨头对人工髋关节置换术患者高交联聚乙烯髋臼内衬的影响比较

摘要

Objective To investigate the effects of different diameters of femoral head on the acetabular liner of high cross linked polyethylene (cros-linked polyethylene highly,HXLPE) in total hip arthroplasty.Methods 68 patients with artificial total hip arthroplasty were selected,according to the different diameters of femoral head,they were divided into two groups: group A and group B,group A (n=36) with average diameter (26 mm,28 mm) ball head HXLPE on acetabular liners,while group B (n=32) treated with large diameter (32 mm,36 mm,40 mm) ball head HXLPE on acetabular liner.The hip function score,the acetabular abduction angle,the stable bone ingrowth rate,the cumulative penetration displacement value of the femoral head and the linear wear rate of both groups was compared.Results The hip joint function score of two groups after operation was significantly improved compared with preoperative (P<0.05);but no significant difference was observed preoperative and postoperative 3 months,6 months,1 year,2 years,3 years in both groups (P>0.05).The linear wear rate of A group was (0.025±0.004) mm/ years,while it was (0.024±0.003) mm/ years in B group,there was no significant difference between the two groups (t=1.7778,P=0.1033).Conclusion There is no significant effect of different diameter of femoral head on the wear rate of HXLPE acetabular liner,and the HXLPE acetabular lining is an ideal surgical material for artificial articular surface.%目的 探讨人工髋关节置换术中采用不同直径股骨头对高交联聚乙烯(HXLPE)髋臼内衬的影响.方法 行人工全髋关节置换术患者68例,按股骨头不同直径分为A、B两组,A组36例,普通直径(26 mm、28 mm)球头HXLPE髋臼内衬,B组32例,采用大直径(32 mm、36 mm、40 mm)球头HXLPE髋臼内衬.比较两组患者髋关节功能评分、髋臼外展角、假体获稳定的骨长入固定比率、股骨头累积穿透位移值和髋臼内寸衬线性磨损率.结果 两组术后髋关节功能评分较术前明显改善(P<0.05);两组术前、术后3个月、6个月、1年、2年、3年髋关节功能评分比较差异无统计学意义(P>0.05).手术后,X线片显示A组髋臼外展角与B组差异无统计学意义(t=0.554,P=0.587).A 组末次随访时34髋(94.44%)假体获稳定的骨长入固定与B组的30髋(93.75%)比较,无统计学差异(χ2=1.773,P=0.872);稳定的纤维长入固定见剩余2髋;未见髋臼假体移位和股骨假体移位、下沉影像.两组于术后3年发现髋臼1、2、3 区X线透亮带(均<1 mm)影像各1例(1髋);未见股骨假体周围透亮带.两组手术后,股骨头累积穿透位移值为正,且术后3 年内股骨头累积穿透位移值两组比较,无显著性差异.A组术后线性磨损率为(0.025±0.004)mm/年,B组线性磨损率为(0.024±0.003)mm/年,组间比较,差异无统计学意义(t=1.7778,P=0.1033).结论 人工髋关节置换术中股骨头直径对HXLPE髋臼内衬磨损率无明显影响,HXLPE髋臼内衬是人工关节面理想的手术材料.