微创小切口大头金属-金属与常规金属-聚乙烯全髋置换术早期临床疗效的对比研究

目的：比较微创小切口大头金属-金属（large—diameter metal—on—metal，L—MoM）全髋置换术（total hip arthroplasty，THA）与常规金属-聚乙稀假体（metal on polyethylene，MoPE）THA的早期临床疗效。方法：2005年1月至2007年12月经后外侧小切口行L—MoM THA20例（22髋）、常规THA20例（22髋）。对两组分别进行临床功能、影像学评价及并发症评估并相互比较。结果：L—MoM组19例（21髋）、MoPE组18例（20髋）获得随访，平均随访时间14．1月。两组Harris评分、简易12项表（short form-12，SF-12）评分及并发症无显著性差异（P〉0．05）；影像学上股骨头相对髋臼中心的矢量位移L—MoM组较MoPE组显著降低（P〈0．01），透亮线、股骨柄中置、异位骨化、骨溶解、假体松动、股骨距吸收、假体断裂两组无显著差异（P〉0．05）。结论：经后外侧小切口行L—MoM THA可取得与常规MoPE THA相似的早期临床疗效，并不会增加手术并发症，且髋臼磨损率更低，其中长期临床结果仍有待进一步研究。

A comparative assessment of short-term outcomes of large-diameter metal-on-metal versus conventional metal on poly ethylene in total hip arthroplasty following minimally invasive

Objective：To compare the short - term clinical effect of large - diameter metal - on - metal（ L- MoM ） versus conventional metal on poly ethylene （MoPE） in total hip arthroplasty （THAi following posterolateral minimal incision. Methods： 22 L- MoM THA in 20 patients were performed with posterolateral minimal incision during Jan 2005 to Dec 2007. A matched group of 22 hips in 20 patients who had undergone a MoPE THA with posterolateral minimal incision performed by the same surgeon were also followed for average of 14.1 months. The two groups of patients were evaluated clinically and radiographically respectively. Results：There were no differences between the two groups with regard to the Harris hip score, the short form- 12（SF- 12） physical and mental component scores, radiographic evaluations（ including radiolucent line, osteolysis, prosthetic loosening and femoral calcar absorption, femoral stemvarus or valgus, heterotopic ossification and implant, fracture）, and major complications（ including thigh pain, deep venous thrombosis, nerve injury, deep infection, dislocation and inequality of lower limb）. Statistically significant differences were found in two groups in terms of the migration in the femoral head center relative to the cup shell center. Conclusion： L- MoM THA with posterolateral minimal incision can be effectively performed without increased risk of complications. Significant benefits of L- MoM include less acetabular wear. Its short term result is satisfactory, but the medium and long term effection still need the further research.