【摘要】：目的 通過對(duì)應(yīng)用第四代陶瓷假體行人工全髖關(guān)節(jié)置換術(shù)的患者的短期隨訪研究，以評(píng)價(jià)其短期臨床效果。 方法 2011年11月-2014年6月，于我院住院手術(shù)治療、經(jīng)影像學(xué)檢查確診的76例懫用第四代陶瓷全髖關(guān)節(jié)假體患者，排除失訪8例后剩余68例，資料完整。其中男39例，女29例，年齡22-63歲，平均年齡42.5歲，共92髖（雙髓24例，單髖44例）。所有患者均行全髖關(guān)節(jié)置換術(shù)，均采用第四代陶瓷全髖關(guān)節(jié)假體，46例髖應(yīng)用的為大直徑陶瓷頭假體組合。所有病例為初次全髖關(guān)節(jié)置換，其中部分患者（6例）分期行雙側(cè)全髖置換術(shù)。術(shù)前對(duì)所有患者進(jìn)行雙髖關(guān)節(jié)常規(guī)查體、影像學(xué)檢查，Hariss評(píng)分（表一術(shù)后隨訪了解患者髖關(guān)節(jié)的活動(dòng)度、術(shù)后lianss評(píng)分、并發(fā)癥及患者滿意度等情況，并對(duì)比患者末次術(shù)影像學(xué)檢查，結(jié)合Greun股骨分區(qū)和Delee-Chanley髖臼側(cè)分區(qū)進(jìn)行影像學(xué)評(píng)估，，異位骨化采用Brooker分級(jí)法分級(jí)。 結(jié)果 68例患者均獲得隨訪，隨訪6-36個(gè)月不等，平均21個(gè)月。術(shù)前hariss評(píng)分為18-52分，平均35分，術(shù)后末次隨訪hariss評(píng)分為95-98分，平均96.5分，術(shù)前與術(shù)后末次隨訪liariss評(píng)分比較有統(tǒng)計(jì)學(xué)意義（p0.05)。所有病人術(shù)中、術(shù)后均無血管神經(jīng)損傷、血栓栓塞、感染、假體脫位、假體周圍骨折及明顯下肢短縮，末次X線檢查均顯示假體位置固定良好，無明顯透亮線、骨溶解、異位骨化及假體松動(dòng)、假體碎裂等征象。其中1例出現(xiàn)術(shù)后髖關(guān)節(jié)異響，未做任何處置，術(shù)后1年左右異響消失。通過術(shù)前術(shù)后Harris評(píng)分、術(shù)后疼痛持續(xù)時(shí)間、并發(fā)癥、滿意度及影像學(xué)對(duì)比，治療效果優(yōu)良率98.53%，術(shù)后髖關(guān)節(jié)功能獲得極大提高。 結(jié)論 第四代陶瓷假體有著良好的短期臨床療效，是由其超高的硬度、韌度、耐磨性及穩(wěn)定性所決定，其中，許多研究認(rèn)為應(yīng)用大直徑陶瓷股骨頭假體效果更佳，其優(yōu)點(diǎn)有極低的關(guān)節(jié)脫位率，更大度數(shù)的髖關(guān)節(jié)活動(dòng)度，以及本體感覺可能性提高等，患者術(shù)后的生活質(zhì)量得到了顯著改善，也為年輕、活動(dòng)量大的患者提供了一種較為理想的假體類型。異響發(fā)生率為1.09%，其機(jī)制有待進(jìn)一步研究。
[Abstract]:Objective to evaluate the short-term clinical effect of total hip arthroplasty with fourth generation ceramic prosthesis. Methods from November 2011 to June 2014, 76 patients with fourth generation ceramic total hip prosthesis were treated by surgery in our hospital from November 2011 to June 2014. The data of the remaining 68 cases were complete after 8 cases were excluded. There were 39 males and 29 females, aged 22-63 years, with an average age of 42.5 years. There were 92 hips (24 cases with double medulla and 44 cases with single hip). All the patients underwent total hip replacement. The fourth generation ceramic total hip prosthesis was used in 46 cases with large diameter ceramic head prosthesis. All cases were treated with primary total hip replacement, and some patients (6 cases) underwent bilateral total hip replacement by stages. All the patients were examined by routine hip joint examination before operation, and by imaging examination and Hariss score (Table 1, follow up after operation to find out the hip motion, postoperative lianss score, complications and patient satisfaction, etc.) Compared with the imaging examination of the last operation, combined with Greun femur division and Delee-Chanley acetabular lateral division, the ectopic ossification was graded by Brooker classification. Results 68 patients were followed up for 6-36 months with an average of 21 months. The preoperative hariss score was 18-52 points (mean 35 points) and the last follow-up hariss score was 95-98 points (average 96.5 points). There was significant difference in liariss score between preoperative and postoperative follow-up (p0.05). No vascularized nerve injury, thromboembolism, infection, prosthesis dislocation, periprosthetic fracture and lower extremity shortening were found in all patients. Ectopic ossification and loose prosthesis, prosthesis fragmentation and other signs. In one case, the abnormal sound of hip joint disappeared about 1 year after operation without any treatment. Through preoperative and postoperative Harris score, postoperative pain duration, complications, satisfaction and imaging comparison, the excellent and good rate of treatment was 98.53, postoperative hip joint function was greatly improved. Conclusion the fourth generation ceramic prosthesis has a good short-term clinical effect, which is determined by its high hardness, toughness, wear resistance and stability. It has the advantages of extremely low dislocation rate, greater hip motion, and increased proprioceptive possibility. The quality of life of the patients after operation has been significantly improved, and it is also young. Patients with high levels of activity provide an ideal type of prosthesis. The incidence of abnormal noise was 1.09, and its mechanism needs further study.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.42

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本文編號(hào)：2198512