骨水泥股骨柄结果

不论是骨水泥型股骨柄还是髋臼都表现出令人满意的长期（15年）效果。这一结论对各种疾病组青年患者和老年患者都适用。挪威和瑞典髋置换术登记数据显示，骨水泥型抛光锥形柄能收到良好效果。15年的随访显示Exeter和Charnley全髋置入物（臼杯和柄）有类似的结果。

在20世纪80年代，全髋置换术中非骨水泥柄的使用逐渐普及，但很多医师仍将带有关节头的骨水泥金属柄和骨水泥全聚乙烯臼杯视为金标准。挪威关节成形术登记机构的数据表明骨水泥和非骨水泥柄在年轻和年老患者中都表现出较好的效果。在60岁以下的患者中，非骨水泥柄的效果稍好于骨水泥柄。在挪威效果最好的非骨水泥柄是HA涂层的Corail柄，其15年的生存率为95.1%。在＜60岁的患者中，Corail柄12年的生存率为96.2%。由于大腿疼痛情况的增加，非骨水泥柄已受到不断地关注。在一项随机的研究中发现，非骨水泥置入物大腿疼痛的发生率为17%，骨水泥置入物大腿疼痛的发生率为3%。人们越来越关心：若羟基磷灰石消失了将会发生什么，无菌性松动会更容易发生吗？

骨水泥柄因其较长的生存率和较低的疼痛发生率而受到好评。在骨水泥型柄中Exeter柄的效果最好，其15年生存率为97.0%。在低于60岁的患者中，Exeter柄的12年生存率为95.2%。不同类型的骨水泥柄的效果是有区别的，抛光锥形Exeter柄的生存率优于直的Vaquashined Charnley柄。这些结果与瑞典髋注册数据中的Exeter置入物数据很好地吻合。

仅仅评估组件的一部分来下结论是武断的，应根据整套假体（臼和柄）来下结论。Exeter和Charnley型置入物的整体效果在所有患者和在低于60岁的年轻患者中是一样的，其原因是Charnley臼杯组件的翻修率低。这很可能是因为Charnley置入物的头（22.2mm）相对于Exeter置入物（28mm和30mm）较小。较小的头磨损率较小，进而使髋臼组件的无菌性松动较少发生。

非骨水泥置入物的结果与骨水泥置入物的相比较差，因为压配形HA涂层髋臼杯更易发生无菌性松动和聚乙烯磨损，压配形半球多孔涂层髋臼杯更易发生聚乙烯磨损和骨溶解。

在一项研究中，为了评价髋诊断的影响，以骨水泥型Charnley假体作为对照组发现年轻患者髋疾病不良的预后是由于这些年轻患者被施予不良的非骨水泥型髋置入物。在20世纪80年代，这些置入物被认为比骨水泥假体具有更好的效果。但在过去的15年这些置入物大量地失败了。失败的原因是由于非骨水泥光滑的压配柄，光滑面的螺旋臼，非环形的多孔涂层导致的无菌性松动。若骨水泥型Charnley假体配合Palacos或Simplex这样有良好记录的骨水泥，则不论疾病的诊断对年轻患者还是年老患者其置入物的生存率均较高。

挪威注册的数据提供了可观的证据，对任何年龄的患者组骨水泥型柄和臼杯的长期生存率都较高。挪威研究机构对年轻患者使用带有头（22mm）的骨水泥型置入物（柄和臼都为骨水泥型）。在超过80岁的老年患者中，聚乙烯磨损问题可以忽略但脱位问题较严重，对这类患者认为应使用32mm股骨头。

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