肝硬化患者的人工髋关节置换  

Total Hip Arthroplasty in Patients with Liver Cirrhosis

作　　者：李文波[1] 张文明[1] 白国昌[1] 黄子达[1] 张超凡[1] 张泽宇[2] 

机构地区：[1]福建医科大学附属第一医院关节外科,福州350005 [2]福建医科大学研究生院,福州350122

出　　处：《福建医科大学学报》2017年第1期44-48,共5页Journal of Fujian Medical University

基　　金：福建省临床重点专科建设项目;福建省卫生系统中青年骨干人才培养项目(2014-ZQN-JC-19);福建省卫生计生委医学创新课题(2014-CX-23);福建省卫生厅青年科研课题(2013-2-41)

摘　　要：目的探讨肝硬化患者行人工髋关节置换围术期的治疗方法。方法收集因不同原因导致肝硬化并行人工髋关节置换手术的患者16例(肝硬化组)和非肝硬化患者32例(对照组),2组均为同期因股骨颈骨折和股骨头坏死行人工髋关节置换的病例。观察2组的并发症,术前、术后行Harris评分及功能评价,并至少随访1年,保留假体清创术的病例至少随访2年。结果肝硬化组术后Child-Pugh分级A级7例,B级8例,C级1例;术后伤口渗出6例;伤口浅表感染3例,给予清创换药、使用抗生素治疗,伤口愈合;伤口周围血肿4例;急性人工关节假体周围感染5例,其中表皮葡萄球菌感染4例,保留假体清创随访2年以上无复发,假体无松动,另一例为金黄色葡萄球菌感染,保留假体清创失败。对照组术后伤口渗出2例,未出现浅表伤口感染、周围血肿、关节感染等。2组在住院时间、手术时间、总费用等方面比较,差别具有统计学意义(P<0.05)。结论肝硬化患者行人工髋关节置换手术风险较大,术后并发症多,特别是感染和出血,术前需做详细准备。Objective To investigate the perioperative treatment method of artificial hip replacement for cirrhotic patients.Methods From June 2008 to December 2014,16 patients with cirrhosis parallel caused by various reasons underwent hip replacement surgery,including 14 males and 2 females,aged（55.4±9.1）years（range from 41 to 64.5 years）.There were 12 cases of femoral head necrosis,4 cases of femoral neck fracture;14 cases of alcoholic cirrhosis.Two cases of cirrhosis of the liver were caused by hepatitis B virus;11 cases were classified as Child-Pugh class A,4 case were classified as grade B,1 case was classified as grade C,all were unilateral.Paired by gender,height,weight,disease and 1：2 ratio,32 cases were collected in the control group for the same period,with femoral neck fracture and femoral head necrosis undergoing artificial hip replacement,including 28 male patient and 4 female patients,of age（57.4±10.2）years（range from 47.2 to 67.6 years）.Femoral head necrosis were presented in 24 cases,femoral neck fracture in 8 cases.Both groups were observed for complications,preoperative and postoperative Harris score and functional evaluation and follow-up for at least one year,while retaining debridement prosthesis patients were followed for at least 2 years.Results In the cirrhosis group（group A）there were 7 cases of postoperative Child-Pugh class A,8 cases of grade B,1 case of grade C;in the control group（group B）,no cirrhosis occurred.There were six cases of postoperative wound exudate in Group A,while there was no superficial wound infection,peripheral hematoma,or postoperative joint infections in Group B.The patients with superficial wound infection were given clear Chong dressing and antibiotics and thewound healed.Four patients were with hematoma Five with acute peripheral prosthesis infection,including Staphylococcus epidermidis infection in 4 cases,underwent debridement and retention of prosthesis then were followed up for 2 years without recurrence,no prosthesis loose.Staphylococcus a

关 键 词：人工关节 髋关节 关节成形术 置换 髋 肝硬化 

分 类 号：R687.4[医药卫生—骨科学] R575.2[医药卫生—外科学]