人工全髋关节翻修:85例随访  

Reversion after total hip arthroplasty: a follow-up of 85 cases

作　　者：李会杰[1] 鲍杰 高子梅 

机构地区：[1]河北医科大学第三医院骨病科,河北省石家庄市050051 [2]河北医科大学第四医院放射科,河北省石家庄市050000

出　　处：《中国组织工程研究》2017年第23期3640-3645,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着接受人工髋关节置换手术的数量逐年增加,因假体本身的寿命以及各种并发症的发生,需行人工全髋关节翻修手术的数量也呈上升趋势。目的:探讨、分析人工全髋关节翻修术的原因、翻修假体临床应用、近期效果及相关翻修技术。方法:回顾性分析85例全髋关节翻修术患者临床资料,23例患者翻修时采用生物型T.O.P髋臼杯(异体骨块植入)加聚乙烯内衬,51例钛网杯加用骨水泥固定,11例超大型臼杯;普通柄63例(其中47例采用骨水泥固定),加长柄34例(组配型假体16例,18例骨水泥固定),采用Harris评分评估翻修髋关节功能。结果与结论:85例全部获得随访,平均随访30.2个月。(1)Harris评分:由术前平均30.07分,翻修术后增至平均90.32分;伤口愈合良好,无脱位、感染患者,并且髋关节功能活动获得了极大改善;(2)分析结果,假体的无菌性松动是翻修最主要原因,其次为假体的脱位;髋臼壁骨缺损以及股骨骨量减少是翻修过程中主要难题;术前对翻修术中可能出现的情况和意外做好充分准备,根据骨缺损情况合理选择假体,早期行人工全髋关节翻修获得良好的临床疗效。BACKGROUND： With the prevalence of total hip arthreplasty, the demand for revision has been increased due to the prosthesis life and various complications. OBJECTIVE： To retrospectively analyze the reasons and clinical effectiveness of revision, clinical application of revision prosthesis, and related revision techniques. METHODS： Clinical data of 85 patients undergoing total hip revision were analyzed retrospectively. Among which, there were 23 cases of biological T.O.P acetabular cup （aUograft bone graft） plus polyethylene liner, 51 cases of titanium mesh cup plus bone cement fixation, and 11 cases of common acetabular cup; common hip stem in 63 cases （including 47 cases of bone cement fixation）; lengthened hip stem in 34 cases （16 cases of modular prosthesis and 18 cases of bone cement fixation）. Subsequently, the hip function was assessed by Harris hip scores.RESULTS AND CONCLUSION： All cases were followed up, and the mean follow-up was 30.2 months. （1） The average Harris hip scores changed from preoperative 30.07 to postoperative 90.32. The wound healed well, no dislocation or infection, and the hip function was improved significantly. （2） To conclude, aseptic loosening of the prosthesis is the main cause of reversion occurred, followed by prosthesis dislocation. Acetabular wall bone defect and decrease in bone mass are the main problems in revision. Adequate preoperative preparation for possible and unexpected events, and reasonable selection of prosthesis according to the bone defects will be helpful. Noticeably, early arthroplasty reversion will obtain good clinical efficacy.

关 键 词：骨科植入物 人工假体 人工髓关节 翻修术 原因 髋关节假体 

分 类 号：R318[医药卫生—生物医学工程]