Objective: To explore the mid-term effectiveness of large-head metal-on-metal total hip arthroplasty (THA).
Methods: A retrospective analysis was made on the clinical date of 40 patients (43 hips) who were treated with the large-head metal-on-metal THA between April 2009 and June 2010. There were 18 males (20 hips) and 22 females (23 hips) with an average age of 55.1 years (range, 20-85 years). Unilateral hip was involved in 37 cases and bilateral hips in 3 cases. The disease causes included osteonecrosis of the femoral head in 14 cases (15 hips), osteoarthritis in 6 cases (7 hips), rheumatoid arthritis in 4 cases (4 hips), femoral neck fracture in 4 cases (4 hips), and developmental dysplasia of the hip in 12 cases (13 hips). Before operation, the Harris score and University of California Los Angeles (UCLA) score were 38.51±5.62 and 4.21±1.43, respectively. The visual analogue scale (VAS) score was 6.78±0.95.
Results: All patients were followed up 6.7-8.3 years (mean 7.5 years). All incisions healed primarily and no neurovascular injury, infection, and hip dislocation occurred. At last follow-up, the Harris score and UCLA score were 93.33±3.21 and 7.32±1.45, respectively, showing significant differences when compared with preoperative scores ( t=51.753, P=0.000; t=23.232, P=0.000). The thigh pain occurred in 3 cases (3 hips) in whom the inflammatory pseudotumor of soft tissues was found in 1 case (1 hip). Postoperative X-ray films showed that the acetabular abduction angle and anteversion angle were (46.5±3.2)° and (14.8±3.6) °, respectively. The initial stability of femoral stem prosthesis was excellent in 39 hips and good in 4 hips according to Mulliken standard. Osteolysis occurred in 2 hips and revision was performed in 1 hip of secondary loosening of prosthesis. The rest patients had no prosthesis loosening or sinking.
Conclusion: The mid-term effectiveness of large-head mental-on-mental THA in treatment of the terminal diseases of hips are good.
目的: 探讨大直径股骨头金属-金属人工全髋关节置换术（total hip arthroplasty，THA）的中期疗效。.
方法: 回顾性分析 2009 年 4 月—2010 年 6 月收治并接受大直径金属-金属 THA 治疗 40 例（43 髋）患者临床资料。其中男 18 例（20 髋），女 22 例（23 髋）；年龄 20～85 岁，平均 55.1 岁。单髋 37 例，双髋 3 例。股骨头缺血性坏死 14 例（15 髋），原发性骨关节炎 6 例（7 髋），类风湿性关节炎 4 例（4 髋），股骨颈骨折 4 例（4 髋），先天性髋关节发育不良 12 例（13 髋）。术前髋关节 Harris 评分为（38.51±5.62）分，美国加州大学洛杉矶分校（UCLA）评分为（4.21±1.43）分，疼痛视觉模拟评分（VAS）为（6.78±0.95）分。.
结果: 患者均获随访，随访时间 6.7～8.3 年，平均 7.5 年。术后切口均Ⅰ期愈合，无神经、血管损伤以及感染、关节脱位等并发症发生。末次随访时，Harris 评分为（93.33±3.21）分、UCLA 评分为（7.32±1.45）分，与术前比较差异均有统计学意义（ t=51.753， P=0.000； t=23.232， P=0.000）。术后 3 例（3 髋）发生大腿疼痛，其中 1 例出现软组织炎性假瘤。X 线片复查示，髋臼外展角及前倾角分别为 （46.5±3.2）、（14.8±3.6）°；股骨柄假体初始稳定质量按照 Mulliken 标准评定，获优 39 髋、良 4 髋。随访期间，2 髋发生骨溶解，其中 1 髋继发假体松动行翻修术；其余患者假体无松动、下沉。.
结论: 大直径股骨头金属-金属 THA 治疗髋关节终末疾病中期疗效良好。.
Keywords: Total hip arthroplasty; large-head prosthesis; metal-on-metal; mid-term effectiveness.