非感染性人工髋关节翻修术28例  

Revision of non-infective total hip replacement in 28 cases

作　　者：王晓军[1] 王爱民[1] 赵玉峰[1] 杜全印[1] 王子明[1] 吴思宇[1] 汤守营[2] 

机构地区：[1]第三军医大学附属大坪医院野战外科研究所全军战创伤中心创二(骨创伤)科,重庆现在400042 [2]张家口解放军第二五一医院骨关节科

出　　处：《中华创伤杂志》2005年第11期822-825,共4页Chinese Journal of Trauma

摘　　要：目的探讨非感染性人工髋关节翻修的原因、术中常见的困难及对策。方法1994年1月-2004年12月收治的28例中,男17例,女11例;年龄42～87岁,平均65.5岁。左侧13髋,右侧15髋。假体松动14例,臼松动11例,柄松动3例;股骨侧假体下沉4例;髋臼磨透3例;股骨柄假体过长3例;合并股骨假体周围骨折1例;股骨柄穿通皮质1例;头臼不匹配1例;臼后倾1例。股骨柄假体15例取出顺利,13例取出困难。结果翻修成功27例,失败1例。全部患者经6个月～8年随访,平均3年7个月。Harris评分术前平均为45分,随访时评分平均为84分。结论(1)无菌性松动和医源性错误是非感染性人工髋关节翻修的主要原因;(2)人工关节翻修手术难度大,术前要做好周密的准备,没有手术经验的医师尽量不要尝试;(3)股骨柄假体取出困难是髋关节翻修中常见的难题,骨水泥型更为突出;(4)术后科学的康复锻炼对功能恢复十分重要。Objective To analyze the reasons, difficuhies and countermeasures for revision of total hip replaeement. Methods A retrospective study was done on revision of non-infective total hip replacements in 28 eases that were admitted from January 1994 to December 2004. There were 17 males and 11 females, with age range from 42 to 87 years （mean 65.5 years）. There were 13 sides of left hip and 15 sides of right hip. The reasons for revision included aseptic loosening in 14 hips （loosening of the stem in three hips and that of the cup in 11 hips） , femoral stem subsidence in four, acetabulum cup penetration in three, excessive long prosthesis stern in three, femoral fracture around the prostheses in one, femoral stem penetration in one, femoral head and cup mismatching in one and acetabulum cup posterior tilt in one. The prostheses components were removed suceessfully in 15 hips but on the contrary in 13. Results Of 28cases, 27 eases were successfully revised except for one hip that resulted in failure. All cases were followed up for six months through eight years （ average three years and seven months）. Harris＇ score was 45 points preoperatively and 84 points postoperatively. Conclusions （ 1 ） The main reasons for revision of non-infective total hip replac.ements are aseptic loosening and iatrogenic reason. （ 2 ） The revision operation is difficuh. Careful preparation before revision is important to success. （3） The common problem of hip revision is difficuhy in removing of the femoral stem, especially in revision of cemented total hip replacements. （4） The reasonable postoperative rehabilitation is very important for functional recovery.

关 键 词：股骨颈骨折 关声成形术 置换 髋 髋假体 翻修术 人工髋关节翻修术 非感染性 Harris评分 股骨柄假体 无菌性松动 股骨假体周围骨折 

分 类 号：R687.4[医药卫生—骨科学] R730.52[医药卫生—外科学]