非骨水泥长柄假体在髋关节翻修术中的应用  

Cementless long-stem prosthesis in revision hip arthroplasty

作　　者：胡钦胜[1] 杨静[1] 沈彬[1] 周宗科[1] 康鹏德[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华关节外科杂志（电子版）》2013年第5期21-24,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：2013卫生行业科研专项(201302007)

摘　　要：目的回顾性分析非骨水泥全涂层长柄假体在全髋关节翻修术中应用的临床疗效。方法对2006年1月至2011年1月四川大学华西医院收治的采用全涂层长柄假体全髋关节翻修术的53例患者（53髋）进行随访、分析。其中男26例，女27例；年龄49—78岁，平均62岁。股骨假体采用强生（Depuy）公司全涂层长度为165mm的直柄AML假体10例、全涂层165mm的Solution假体19例和203mm带弧度分左右侧的Solution假体24例。比较髋关节术前术后的Harris评分，x线片评价假体柄有无松动下沉及应力遮挡情况。结果53例患者均获随访，随访时间1．8～6．8年，平均4．7年。术前平均Harris评分为37分，最后随访时增加至86分。所有患者均在术后3个月后完全负重，原有髋关节疼痛缓解。在最后随访时，有45例股骨柄假体获得骨长人固定。并发症：术后脱位1例，手法复位后未再发生脱位，术后感染1例，假体柄明显下沉1例，后两例患者行再次翻修术，末次随访假体柄稳定。随访X线片显示多数患者骨质改建，密度增加，未发现假体周围有连续亮带及假体柄下沉的患者。结论复杂的股骨侧翻修手术，应尽可能选择非骨水泥长柄假体。特别是股骨干骺端骨质条件差，中段有骨缺损，近端不能获得牢固固定的病例。术中结合同种异体颗粒骨打压植骨处理股骨中上段中重度骨缺损，中期临床疗效良好，远期效果有待随访。Objective To retrospectively analyze the efficiency and mid-term clinical outcomes of cementless long-stem prosthesis for revision total hip arthroplasty （THA）. Methods From January 2006 to January 2011, 53 patients （53 hips ） underwent revision hip arthroplasty using cementless long-stem prosthesis. The reasons for revision included： osteolysis/aseptic loosening （32 cases）, infection （10 cases）, and periprosthetic fractures（ 11 cases）. There were 10 cases using 165mm straight-stem AML prosthesis, 19 cases using 165ram Solution prosthesis, and 24cases using 203ram curved-stem Solution prosthesis. The patients were followed up to observe the clinical and radiological results. The stem subsidence, periprotheric fracture, infection and other complications would be recorded. Results The mean follow-up time was 4.7 years. Harris Scores improved from 37 points pre-operation to 86 points at the final follow-up. Dislocation occurred in one case postoperatively at one month, which was treated with close reduction. One case had infection after revision and treated by further two-stage revision. One case had significant subsidence six months after revision surgery and underwent second revision with a longer stem. Radiographic analysis showed all stems were stable and bone graft incorporation could be observed in the X- ray images at the end of the follow-up. The proximal cortical bone mineral density and thickness of cortical hone had increased. Conclusion Cementless long-stem prosthesis should he considered in complicated revision hip arthroplasty, especially in those with bone defects in the middle femoral shaft. Impactedmorsellized cancellous allograft combined with cementless long-stem prosthesis is an efficacious choice to restore bone stock and get good press-fit fixation. Mid-term clinical and radiographic outcomes are encouraging. Further follow-up is needed to confirm the long-term results.

关 键 词：关节成形术  置换  髋 非骨水泥全涂层长柄假体 翻修 并发症 股骨假体 

分 类 号：R687.4[医药卫生—骨科学]