人工髋关节翻修的临床回顾与分析  

REVIEW AND ANALYSIS OF REVISION OF TOTAL HIP REPLACEMENT

作　　者：于进祥[1] 孙剑平[1] 杜东鹏[1] 雷林革[1] 张义福[1] 

机构地区：[1]解放军第一医院骨科,兰州730030

出　　处：《中国修复重建外科杂志》2004年第5期380-382,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　评价人工髋关节翻修术的临床价值 ,分析导致翻修的原因、术中常见的困难及处理办法。　方法　对 1998年 6月～ 2 0 0 2年 1月行全髋翻修术的 15例 15个髋临床资料进行统计、分析 ,找出其特点。翻修的原因主要为 :初次手术技术失误 ,假体松动下沉 ,假体位移 ,髋臼磨损下陷、上移 ,股骨假体柄断裂等。翻修术的主要难点为 :患者年龄偏高 ,全身情况差 ;初次置换假体取出以及骨水泥取出较为困难 ;常有骨缺失 ,处理有一定难度。提出髓腔内断裂假体取出的办法。　结果　 15例翻修术获 8个月～ 4年 10个月随访 ,平均 2 .4年。 2例术后 3年因心、脑血管病死亡。其余效果良好 ,未出现感染、脱位及松动等并发症 ,功能满意。翻修术后效果好的原因主要与其病情较轻 ,无严重的骨缺失 ,初次手术多为股骨头置换等有关。　结论　随着人口老龄化 ,临床上对翻修术的要求日趋增多。因手术难度较大 ,需一定的技术、经验、特殊器械及设备 ,术者应有充分的准备 。Objective To evaluate the clinical value of the revision of total hip replacement(THR), to analyse the reason of the revisions, and to discuss the main difficulties and measures to manage it. Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on total hip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR, especially the broken femoral stem and the cements; the loss of local bone. The measures to remove the broken femoral stem were described. Results All cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others. No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement. Conclusion The revision of THR is a more difficult operation, so that the special instrument and equipment and operative experience are required.

关 键 词：翻修术 临床回顾 人工髋关节 假体取出 并发症 术后 效果 功能 松动 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]