人工全髋关节置换术后髋臼假体初始不稳定原因分析及处理  

REASON ANALYSIS AND TREATMENT OF ACETABULAR COMPONENT INITIAL INSTABILITY AFTER PRIMARY TOTAL HIP ARTHROPLASTY

作　　者：蔡碰德[1] 胡懿郃[1] 文霆[1] 钟达[1] 冷屹[1] 雷鹏飞[1] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中国修复重建外科杂志》2011年第12期1418-1421,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨初次人工全髋关节置换术后髋臼假体初始不稳定的原因及处理方法。方法回顾性分析2003年1月-2010年6月初次人工全髋关节置换术后出现髋臼假体初始不稳定行髋臼翻修术的19例患者临床资料。男11例,女8例;年龄55～79岁,平均67.2岁。左髋9例,右髋10例。应用骨水泥型髋臼假体7例,非骨水泥型12例。初次置换术后3周～6个月行翻修术,平均4.5个月。分析髋臼假体初始不稳定的原因,比较翻修术前后髋臼假体骨覆盖率及髋关节功能Harris评分。结果髋臼假体初始不稳定与髋臼的处理、假体的选择及放置角度、骨水泥操作技术不当等有关。翻修术后l例出现坐骨神经麻痹,7周后自行恢复;1例髋臼前壁轻微骨折,3个月后骨折愈合。术后切口均Ⅰ期愈合,无关节假体周围感染、血管损伤、假体脱位、下肢深静脉血栓形成等并发症发生。术后患者均获随访,随访时间11～73个月,平均28个月。患者均未出现髋臼假体初始不稳定。髋臼假体骨覆盖率由初次置换时的67.9%±5.5%提高至翻修术后87.7%±5.2%,差异有统计学意义(t=11.592,P=0.003)。末次随访时Harris评分为(84.4±4.6)分,较术前的(56.5±9.3)分显著提高(t=11.380,P=0.005)。结论术前详细计划、选择合适的假体、妥善处理髋臼、按合理角度植入髋臼假体有助于获取良好的髋臼假体初始稳定性。Objective To analyze the main reasons of acetabular component initial instability after primary total hip arthroplasty（THA） and to disscuss the prevention and management.Methods The clinical data were retrospectively analyzed from 19 patients undergoing revision for acetabular component initial instability after primary THA between January 2003 and June 2010.There were 11 males and 8 females,aged from 55 to 79 years（mean,67.2 years）.The locations were left hip in 9 cases and right hip in 10 cases.The cementless hip prosthesis was used in 12 cases and cement hip prosthesis in 7 cases.The revisions were performed at 3 weeks to 6 months after primary THA.The reasons of early failure were analyzed.Both the coverage rate of acetabulum-bone and the Harris hip score were compared between pre-and post-revision.Results The main reason of acetabular component initial instability after primary THA may be unsuitable treatment of acetabulum,improper selection of acetabular component,and incorrect place angle of acetabular component.Sciatic nerve palsy occurred in 1 case and recovered at 7 weeks after revision.Slight fracture of the acetabulum in 1 case and healed at 3 months after revision.All incisions healed by first intention.No infection,vessel injury,displacement of acetabular component,or deep vein thrombosis occurred.The patients were followed up 11-73 months（mean,28 months）.At last follow-up,no acetabular component instability was observed.The coverage rate of acetabulum-bone was increased from 67.9% ± 5.5% before revision to 87.7% ± 5.2% after revision,showing significant difference（t=11.592,P=0.003）.The Harris hip score at last follow-up（84.4 ± 4.6） was significantly higher than that at pre-revision（56.5 ± 9.3）（t=11.380,P=0.005）.Conclusion Detailed surgical plan,proper choice of component,correct place angle and elaborative planning,and proficient surgical skill are necessary to achieve the initial stability of acetabular component in THA.

关 键 词：人工全髋关节置换 初始不稳定 髋臼假体 翻修术 

分 类 号：R687.4[医药卫生—骨科学]