骨水泥與非骨水泥型人工全髖關節置換治療腎移植術后股骨頭缺血性壞死的近期療效比較_《中國修復重建外科雜志》

作者：

虞連奎 ¹ , 戚超 ¹ , 于騰波 ¹ , 孟慶陽 ¹ , 趙夏 ¹ , 劉凱 ¹ , 蔡琰 ²

1青島大學醫學院附屬醫院關節外科（山東青島，266003）;;
2 青島市市立醫院腎臟科;

關鍵詞：

人工全髖關節置換腎移植股骨頭缺血性壞死骨水泥型假體非骨水泥型假體

DOI：

10.7507/1002-1892.20130309

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目的比較初次行骨水泥與非骨水泥型人工全髖關節置換（total hip arthroplasty，THA）治療腎移植術后股骨頭缺血性壞死（osteonecrosis of the femoral head，ONFH）的近期療效。方法回顧性分析2005年2月－2012年2月接受初次THA的18例（21髖）腎移植術后ONFH患者臨床資料，其中11例（13髖）采用骨水泥型假體置換（骨水泥組），7例（8髖）采用非骨水泥型假體置換（非骨水泥組）。兩組患者性別、年齡、病程、ONFH分期、術前Harris評分及骨密度等一般資料比較，差異均無統計學意義（P gt; 0.05）。記錄兩組術后并發癥發生情況，采用Harris評分評定髖關節功能，攝X線片觀察假體情況。結果術后患者切口均Ⅰ期愈合。兩組患者均獲隨訪，骨水泥組隨訪時間為6～77個月，平均46個月；非骨水泥組為4～71個月，平均42個月。術后兩組各1例（1髖）出現股骨假體感染；骨水泥組1例（1髖）發生髖關節脫位，1例（1髖）發生股骨假體松動，1例（1髖）發生髖臼假體松動。末次隨訪時，骨水泥組總體并發癥發生率為30.7%（4/13）、翻修率為23.1%（3/13），顯著高于非骨水泥組的12.5% （1/8）、0 （0/8）（P=0.047， P=0.040）。末次隨訪時，非骨水泥組Harris評分為（94.1 ± 3.7）分，骨水泥組為（90.0 ± 4.2）分，與術前比較差異均有統計學意義（P lt; 0.05）；兩組間比較差異無統計學意義（t=1.815，P=0.062）。X線片復查示，兩組術后假體初始位置均滿意；末次隨訪時，骨水泥組股骨假體骨性固定9髖、纖維固定3髖、松動1髖，髖臼假體松動1髖、其余穩定固定；非骨水泥組股骨假體均骨性固定，髖臼假體均穩定固定。兩組均無異位骨化發生。結論采用非骨水泥型假體初次行THA治療腎移植術后ONFH的近期療效滿意，且優于骨水泥型假體，中遠期療效有待進一步觀察。

引用本文： 虞連奎,戚超,于騰波,孟慶陽,趙夏,劉凱,蔡琰. 骨水泥與非骨水泥型人工全髖關節置換治療腎移植術后股骨頭缺血性壞死的近期療效比較. 中國修復重建外科雜志, 2013, 27(12): 1409-1413. doi: 10.7507/1002-1892.20130309 復制

1.	Alshayeb HM, Josephson MA, Sprague SM. CKD-mineral and bone disorder management in kidney transplant recipients. Am J Kidney Dis, 2013, 61(2): 310-325.
2.	Abdulkarim A, Ellanti P, Motterlini N, et al. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia), 2013, 5(1): e8.
3.	Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res, 2004, (420): 135-141.
4.	Engh CA Sr, Leung S. Cementless stems in patients aged > 60 years: justified use. Orthopedics, 2003, 26(9): 921, 948.
5.	Lim BH, Lim SJ, Moon YW, et al. Cementless total hip arthroplasty in renal transplant patients. Hip Int, 2012, 22(5): 516-520.
6.	中國老年學學會骨質疏松委員會骨質疏松診斷標準學科組. 中國人骨質疏松癥建議診斷標準(第二稿). 中國骨質疏松雜志, 2000, 6(1): 1-3.
7.	Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg (Br), 1993, 75(1): 6-13.
8.	Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2): 177-184.
9.	Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1333-1338.
10.	Caecía-Ramiro S, Cofán F, Esteban PL, et al. Total hip arthroplasty in hemodialysis and renal transplant patients. Hip Int, 2008, 18(1): 51-57.
11.	Orban H, Adam R, Orban C. Arthroplasty risk after kidney or liver transplant. Chirurgia (Bucur), 2012, 107(5): 664-669.
12.	Nozaki Y, Kumagai K, Miyata N, et al. Pravastatin reduces steroid-induced osteonecrosis of the femoral head in SHRSP rats. Acta Orthop, 2012, 83(1): 87-92.
13.	Paydas S, Balal M, Demir E, et al. Avascular osteonecrosis and accompanying anemia, leucocytosis, and decreased bone mineral density in renal transplant recipients. Transplant Proc, 2011, 43(3): 863-866.
14.	Zivci?-Cosi? S, Stalekar H, Mamula M, et al. The role of core decompression for the treatment of femoral head avascular necrosis in renal transplant recipients. Acta Med Croatica, 2012, 66(2): 76-80.
15.	Vogel M, Strach K, Ehren K, et al. Avascular necrosis of the bone after organ transplantation. Internist (Berl), 2010, 51(5): 662, 664-666.
16.	常廷杰, 唐康來, 陶旭, 等. 自體血清培養BMSCs移植結合髓芯減壓治療早期股骨頭缺血性壞死的初步應用. 中國修復重建外科雜志, 2010, 24(6): 739-743.
17.	虞連奎, 于騰波, 趙夏, 等. 骨水泥全髖關節置換對腎移植后股骨頭壞死短期效果. 齊魯醫學雜志, 2013, 28(4): 361-364.
18.	Shrader MW, Schall D, Parvizi J, et al. Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients. J Arthroplasty, 2006, 21(3): 324-329.
19.	Debarge R, Pibarot V, Guyen O, et al. Total hip arthroplasty in patients with chronic renal failure transplant or dialysis. Rev Chir Orthop Reparatrice Appar Mot, 2007, 93(3): 222-227．.
20.	Chang JS, Han DJ, Park SK, et al. Cementless total hip arthroplasty in patients with osteonecrosis after kidney transplantation. J Arthroplasty, 2013, 28(5): 824-827.

1. Alshayeb HM, Josephson MA, Sprague SM. CKD-mineral and bone disorder management in kidney transplant recipients. Am J Kidney Dis, 2013, 61(2): 310-325.
2. Abdulkarim A, Ellanti P, Motterlini N, et al. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia), 2013, 5(1): e8.
3. Engh CA Jr, Hopper RH Jr, Engh CA Sr. Distal ingrowth components. Clin Orthop Relat Res, 2004, (420): 135-141.
4. Engh CA Sr, Leung S. Cementless stems in patients aged > 60 years: justified use. Orthopedics, 2003, 26(9): 921, 948.
5. Lim BH, Lim SJ, Moon YW, et al. Cementless total hip arthroplasty in renal transplant patients. Hip Int, 2012, 22(5): 516-520.
6. 中國老年學學會骨質疏松委員會骨質疏松診斷標準學科組. 中國人骨質疏松癥建議診斷標準(第二稿). 中國骨質疏松雜志, 2000, 6(1): 1-3.
7. Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg (Br), 1993, 75(1): 6-13.
8. Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2): 177-184.
9. Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1333-1338.
10. Caecía-Ramiro S, Cofán F, Esteban PL, et al. Total hip arthroplasty in hemodialysis and renal transplant patients. Hip Int, 2008, 18(1): 51-57.
11. Orban H, Adam R, Orban C. Arthroplasty risk after kidney or liver transplant. Chirurgia (Bucur), 2012, 107(5): 664-669.
12. Nozaki Y, Kumagai K, Miyata N, et al. Pravastatin reduces steroid-induced osteonecrosis of the femoral head in SHRSP rats. Acta Orthop, 2012, 83(1): 87-92.
13. Paydas S, Balal M, Demir E, et al. Avascular osteonecrosis and accompanying anemia, leucocytosis, and decreased bone mineral density in renal transplant recipients. Transplant Proc, 2011, 43(3): 863-866.
14. Zivci?-Cosi? S, Stalekar H, Mamula M, et al. The role of core decompression for the treatment of femoral head avascular necrosis in renal transplant recipients. Acta Med Croatica, 2012, 66(2): 76-80.
15. Vogel M, Strach K, Ehren K, et al. Avascular necrosis of the bone after organ transplantation. Internist (Berl), 2010, 51(5): 662, 664-666.
16. 常廷杰, 唐康來, 陶旭, 等. 自體血清培養BMSCs移植結合髓芯減壓治療早期股骨頭缺血性壞死的初步應用. 中國修復重建外科雜志, 2010, 24(6): 739-743.
17. 虞連奎, 于騰波, 趙夏, 等. 骨水泥全髖關節置換對腎移植后股骨頭壞死短期效果. 齊魯醫學雜志, 2013, 28(4): 361-364.
18. Shrader MW, Schall D, Parvizi J, et al. Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients. J Arthroplasty, 2006, 21(3): 324-329.
19. Debarge R, Pibarot V, Guyen O, et al. Total hip arthroplasty in patients with chronic renal failure transplant or dialysis. Rev Chir Orthop Reparatrice Appar Mot, 2007, 93(3): 222-227．.
20. Chang JS, Han DJ, Park SK, et al. Cementless total hip arthroplasty in patients with osteonecrosis after kidney transplantation. J Arthroplasty, 2013, 28(5): 824-827.

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骨水泥與非骨水泥型人工全髖關節置換治療腎移植術后股骨頭缺血性壞死的近期療效比較

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骨水泥與非骨水泥型人工全髖關節置換治療腎移植術后股骨頭缺血性壞死的近期療效比較

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