目的：探讨大直径（36 mm）股骨头陶瓷对陶瓷全髋关节置换治疗终末期髋关节疾病的适应证、手术技巧及近期临床疗效。方法自2012年11月至2013年12月对51例终末期髋关节疾病患者，采用直径36 mm股骨头陶瓷对陶瓷人工全髋关节行全髋关节置换术。其中男30例，女21例，平均54．2岁（20～79岁），术前诊断：股骨头缺血坏死32例，先天性髋关节发育不良继发骨性关节炎9例，强直性脊柱炎5例，原发骨性关节炎4例，类风湿性关节炎1例。本组均为单侧关节置换，采用Link公司提供的直径36 mm股骨头BIOLOX Delta复合陶瓷对陶瓷（四代陶）界面，髋臼外杯及股骨柄均为生物型。结果该组平均手术时间为85 min（55～130 min），术中平均失血量320 mL（100～1000 mL），随访时间4～15个月（平均7．6月）。随访内容包括Harris评分及X线摄片，Harris评分术前平均46分（28～55分），术后改善至91．2分（82～97分），该组无术后脱位、假体周围感染、深静脉血栓，X线未见异位骨化及假体松动表现，无陶瓷碎裂及髋关节异响。一例并发术中股骨干骨折，行钢丝固定；1例并发臼底骨折，因髋臼假体稳定未做特殊处理，术后3月骨折愈合；1例Crowe Ⅱ型先天性髋关节发育不良者术后自觉有髋关节不稳，仍在进一步随访之中。结论大直径（36 mm）股骨头陶瓷对陶瓷全髋关节置换术后髋关节活动度大，脱位率低，界面磨损率低，更加适合年轻、对髋关节使用要求较高的有关节置换指证的髋关节疾病患者。%Objective To investigate the indication ,operation techniques and clinical effect of end-stage hip disease by ceramic totoal hip replacement with large diameter (36 mm) femoral head.Methods From November 2012 to December 2013 51 cases of end-stage hip disease patients underwent ceramic total hip arthroplasty by the use of 36mm diameter of femoral head .There were 30 male cases and 21 female cases with an average age of 54.2 years(20~79 years).The preoperative diagnosis showed there were 32 cases of avas-cular necrosis of the femoral head ,9 cases of secondary osteoarthritis due to congenital hip dysplasia ,5 cases of ankylosing spondyli-tis,4 cases of primary osteoarthritis ,and 1 case of rheumatoid arthritis .All the replacements were unilateral ones ,with 36mm diameter of femoral head,BIOLOX Delta composite ceramics on ceramic (four generation pottery) interface,acetabular cup and femoral stem being biological type.Results The average operation time,blood loss and the follow-up duration were 85min(55~130min).320ml(100~1 000 mL),and 4~15 months(average 7.6 months).Follow up included Harris score and X-ray.Postoperative Harris score improved from preoperative average 46 points(28~55 points) to 91.2 points(82~97 points).There were no dislocation ,infection,deep vein thrombosis.X-ray results showed no heterotopic ossification and prosthesis loosening ,no ceramic fracture and “squeaking”.There were 1 case of complicated intraoperative femoral shaft fracture ,treated with row wire fixation ,1 case of complicated acetabular bottom frac-ture,which was not treated due to the stability of acetabular prosthesis and healed in 3 months,1 case of DDH(Crowe II ) congenital hip dysplasia,which felt hip instability and was still in further follow-up.Conclusions Large diameter(36mm) of femoral head for ce-ramic total hip replacement ensures more joint activities ,low rate of dislocation ,low interface wear rate ,which is more suitable for young patients.
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