骨科与肌肉系统：当前研究
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使用小直径金属对金属关节瓦格纳锥体假体进行全髋关节置换术治疗发育性髋关节发育不良

罗希特·马赫什瓦里、加文·奥尼尔、安德鲁·马什、谢赫·侯赛因、桑吉夫·帕蒂尔和 RMD 米克

背景

患有发育性髋关节发育不良的患者通常在较年轻时接受全髋关节置换术（THA）。由于髋臼骨量不足、股骨解剖结构异常（前倾角增加）、下肢长度差异和软组织不平衡，此类患者的全髋关节置换术在技术上要求很高。带有金属对金属 (MoM) 28 毫米轴承的锥形股骨柄已用于解决该年轻患者群体的解剖和磨损问题。该研究的目的是回顾该假体的早期中期临床结果。

材料与方法

2004 年 1 月至 2009 年 3 月期间，连续 21 名继发于髋关节发育不良的骨关节炎患者（24 髋）接受了金属对金属非骨水泥 Allofit Metasul 压配杯 (Zimmer)，头部为 28 毫米，锥形非骨水泥 Wagner 锥体使用后路入路的假体柄 (Zimmer)。

使用牛津髋关节评分 (OHS)、SF12 身体和心理评分以及 WOMAC 评分来评估功能结果。由两名独立观察者对下肢长度差异 (LLD)、Crowe 和 Tonnis 分级、横向中心边缘 (CE) 角、髋臼顶弧角和股骨颈干角异向性骨化、假体松动和杯倾斜进行放射线检查结果角度。

结果

There were 5 men and 16 women with mean age of 45 years (SD=9.15, 26-63). The mean follow up was four years (SD=1.7, 2-7). No patients were lost to follow up. Three patients required structural allograft, no patients required intra operative femoral shortening. Classification of DDH was Crowe type I in 14 hips, type II in 8 hips and type III in 2 hips. The mean preoperative CE angle was 10.5°, neck shaft angle was 143° and the acetabular roof arc angle was 25°. 3 hips had Tonnis Grade 2 while 21 had Grade 3 osteoarthritis. The mean cup inclination angle was 42 degrees (range 32-60 degrees). The mean preoperative limb shortening was 19.1 mm (range,-1 to -39) which improved to 2.8 mm postoperatively.

The OHS improved significantly within subjects (p<0.001) from a mean of 10.6 (2-28) to 43.9 (30-48). The mean post operative scores were- WOMAC 51 (SD=7.4, 30-56), SF12 physical 51 (SD=8.5, 28-58) and SF12 mental 53 (SD=4.7, 46-59). There were two revisions for aseptic loosening, one stem and one cup; therefore giving an overall survival of 91%. No other hip had radiographic evidence of acetabular or femoral osteolysis. Three patients suffered transient femoral nerve palsy, which recovered completely. We did not observe any dislocation, deep infection or heterotopic ossification.

Discussion

采用圆锥形非骨水泥柄的小直径金属对金属髋关节置换术在治疗这一困难的年轻患者群体中取得了令人鼓舞的中期结果。小股骨头提供的固有稳定性和功能结果优于最近的大型金属对金属关节。需要进一步跟进，看看小型 MoM 轴承的长期表现如何。