体外冲击波对人工髋关节置换翻修骨水泥股骨假体取出的影响  

Effects of extracorporeal shock wave to the removal of cemented femoral prostheses in the revision of artificial hip replacement

作　　者：孙英华[1] 焦兆德[1] 王莉[1] 郑宪友[2] 王复超[1] 

机构地区：[1]潍坊医学院附属益都中心医院骨科,山东262500 [2]上海交通大学附属第六人民医院骨科,200233

出　　处：《中国骨与关节杂志》2013年第8期452-456,共5页Chinese Journal of Bone and Joint

摘　　要：目的观察体外冲击波对人工髋关节置换翻修骨水泥股骨假体取出的影响。方法患者入选标准：年龄45—79岁，翻修距初次手术时间5—20年；无菌性骨水泥假体松动；单侧翻修；初次手术用国产假体及骨水泥；自愿参加本研究并签署知情同意书。将符合入选标准的32例患者按简单数字随机法分为干预组和对照组，每组16例，干预组术前5天开始，每日1次（2000次脉冲），每次30min，共5次f10000次脉冲）的体外冲击波治疗，对照组术前不行体外冲击波治疗。由同一人按完整拔除标准（一次性完全拔除）、开骨取出标准（无法拔除或仅部分拔除）、耗时计算标准（自开始取时始至全部取出时止）、出血量计算标准（自切皮始至缝皮止）分别统计两组患者数据，并从疼痛、功能、关节活动度、关节畸形4个方面行术前1周及术后1个月Harris评分。结果干预组假体完整拔出者（16例中8例，50．00％）较对照组（16例中2例，12．50％）多（P〈0．05），非完整拔除者干预组开骨者（8例中2例，25．00％）较对照组（14例中10例，71．43％）少（P〈0．05）；干预组取出植入物耗时（310．1±129．5）S较对照组（978．9±110．2）s短（P〈0．01）；干预组术中出血量（610．9±126．5）ml较对照组（1110．1±140．4）ml少（P〈0．01）。Harris评分术前1周干预组（69．1±4．5）与对照组（70．2±5．2）差异无统计学意义（P〉0．05）；术后1个月干预组（94．1±3．5）较对照组（90．9±4．2）高（P〈0．05）。结论体外冲击波利于人工髋关节置换翻修骨水泥股骨假体取出。Objective To investigate the effects of extracorporeal shock wave （ ESW ） to the removal of cemented femoral prostheses in the revision of artificial hip replacement （ AHR ）. Methods The inclusion criteria were stated as following： patients （ 45-79 years old ） underwent revision 5 to 20 years after the initial operation; aseptic loosening of cemented femoral prostheses; unilateral revision and domestic prostheses and bone cements in the initial operation; volunteered to participate in this study and sign informed consents. According to the single or dual number of admission sequence, a total of 32 patients meeting the inclusion criteria were randomly divided into 2 groups： the intervention group （ n=16 ）, who were treated with preoperative ESW therapy once a day for 5 days and 30 minutes each time, amounting to 5 times with 10 000 pulses in all, and the control group （ n=16 ）, who were not treated with preoperative ESW therapy. The same person was in charge of recording the statistical data of the 2 groups according to the 4 standards, including complete removal （ disposable removal ）, cutting femurs and removing the implants （ impossible to eradicate or only partially removed ）, time-consuming calculation （ from the beginning of the removal until all the femoral implants were removed ） and bleeding volume calculation （ from skin incision to skin suture ）. Furthermore, the Harris score was used to evaluate the 4 aspects 1 week before the surgery and 1 month after the surgery, including pain, function, range of motion and joint deformity. Results The cases that the implants were completely removed in the intervention group （ 8 out of 16 cases, 50.00% ） were more than that in the control group （ 2 out of 16 cases, 12.50% ） （ P〈0.05 ）. On the other hand, compared with that in the control group （ 10 out of 14 cases, 71.43% ）, the cases that the femurs were cut and the implants were not completely removed were less in theintervention group （ 2 out of 8 cases,

关 键 词：冲击波 人工髋关节置换 翻修 骨水泥股骨假体 

分 类 号：R687.4[医药卫生—骨科学]