生物型假体在人工髋关节翻修术中的应用  

Revision total hip arthroplasty using a cementless prothesis

作　　者：蒋青[1] 徐志宏[1] 陈东阳[1] 史冬泉[1] 秦江辉[1] 戴进[1] 翁文杰[1] 袁涛[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,关节疾病诊治中心,210008

出　　处：《中华外科杂志》2012年第5期393-397,共5页Chinese Journal of Surgery

摘　　要：目的探讨生物型假体在人工髋关节翻修术中的应用方法和疗效。方法回顾性分析2004年1月至2009年12月行生物型假体人工髋关节翻修术的72例（72髋）患者资料。其中男性41例，女性31例；年龄28-82岁，平均65．7岁。包括髋关节感染2例，无菌性松动54例，假体周围骨折4例，假体柄断裂5例，人工股骨头置换后髋臼磨损7例。记录手术时间、出血量、截骨情况、植骨隋况。观察术后感染、脱位、骨溶解、假体周围骨折、假体移位的发生情况。随访时髋关节功能评估采用Harris评分。结果手术时间70-280min，平均（146±47）min；术中出血量200-2500ml，平均（9704±540）ml。2例患者术中关节液培养提示细菌感染。7例行大粗隆近端截骨，4例行股骨远端开窗。术中股骨假体翻修时发生股骨近端骨折8例。术中共植骨29例，其中自体骨18例，异体骨11例。共67例患者获得随访，随访时间20-92个月，平均66个月。无死亡病例，无神经血管损伤，1例发生感染外院进行翻修，2例患者术后3个月内发生假体脱位行再次翻修手术。植骨部位愈合时间3-5个月。生物型股骨假体的存活率95．5％，生物型髋臼假体存活率为98．4％。Harris评分55-95分，平均（86±8）分。结论生物型假体在人工髋关节翻修术的应用中期疗效满意，术中的初期稳定性对于生物型假体的生存意义重大。Objective To assess the operative technique and results with the usage of cementless prothesis in hip revision. Methods Retrospective study was done on revision of total hip arthroplasty with cementless prothesis in 72 patients （41 males and 31 females） with an average age of 65.7 years （28- 82 years） from January 2004 to December 2009. The reason for revision was 2 infection, 54 aseptic lossening, 4 periprosthetic fractures, 5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty. The operation time, bleeding loss, complications of infection, dislocation, periprosthetic fractures and loosening were evaluated. The Harris score were used for hip function evaluation. Results The average operation time was （146 ± 47 ）minutes（70-280 minutes） and bleeding loss during the operation was （970 ± 540 ） ml （200-2500 ml ）. Bacterium cultivation during operation demonstrated infection in 2 patients. Bone windows at the lateral femoral were opened in 4 patients and extend trochanteric osteotomy was done in 7 patients. Fracture of the proximal femur occurred in 8 cases. Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts. Sixty-seven patients were followed up for an average time of 66 months （20-92 months ）. Additional revisions were performed in 3 cases including 2 dislocations and 1 infection. There were no death, no damage of major blood vessels and nerves. The bone graft healed during 3-5 months. The survival rates of the femoral prothesis and the acetabulum protheses were 95.5% and 98.4%. The mean Harris score was 86 ±8 （55-95 points）. Osteolysis were seen in 13 hips but migration was seen in only 1 patient. Conclusions The cementless prothesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the reliable primary fixation.

关 键 词：关节成形术 置换 髋 髋假体 生物假体 再手术 

分 类 号：R687.4[医药卫生—骨科学]