远端生物固定翻修柄在老年患者髋关节股骨侧翻修中的应用  

Clinical application of uncemented distal stem fixation for revising femoral prosthesis of hip arthroplasty in elderly patients

作　　者：简小飞[1] 陈廖斌[2] 蒋林[1] Jian Xiaofei ,Chen Liaobin, Jiang Lin(Department of Orthopaedics, the Central Hospital of Wuhan , Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014 , China ; Department of Orthopaedics ,Zhongnan Hospital of Wuhan University ,Wuhan 430014 ,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院骨科,430014 [2]武汉大学中南医院骨科,430071

出　　处：《中华老年医学杂志》2018年第10期1122-1125,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨远端生物固定翻修柄在老年患者髋关节股骨侧翻修中的应用及临床效果。方法2005年7月至2013年1月，采用远端固定生物型股骨假体对22例70岁以上非感染性股骨侧假体松动患者进行翻修手术，男12例，女10例；年龄70～85岁，平均76岁，右侧10例，左侧12例，人工股骨头置换术后11例，全髋关节置换术后9例，假体周围骨折2例。根据Paprosky分型，Ⅰ型2髋，Ⅱ型12髋，ⅢA型6髋，ⅢB型2髋。翻修假体：MP（Link），Solution（DePuy）。对翻修术前及随访时的Harris评分情况、影像学资料、临床效果进行回顾性分析。结果平均随访61（48～78）个月，患者Harris评分从术前的38（25～46）分改善至随访结束时的87（76～94）分。所有假体均获初始稳定，无感染、脱位及深静脉血栓等并发症，所有患者可弃拐行走。2例患者有轻度跛行，术后x线显示假体位置良好，无松动、下沉，周围骨质密度和厚度增加。结论远端固定生物型假体可在股骨远端髓腔内获得可靠的轴向及抗旋转初始稳定性，为假体骨长人创造了条件，尤其适用于股骨近端骨缺损轻于PaproskyⅣ型的老年患者的翻修手术，具有良好的短中期效果。Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty. Methods From July 2005 to January 2013,22 patients（12 males and 10 females）aged from 70 to 85 years（average： 76 years old） with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study. Of all patients, 10 had revision on the right side and 12 on the left side; 11 patients received artificial replacement of the femoral head;9 had total hip replacements;2 had femoral fractures. According to the Paprosky classification system, 2 cases were type Ⅰ, 12 were type Ⅱ ,6 were type Ⅲ A,and 2 were type Ⅲ B. Femoral stems for revision included MP（Link）and Solution（Depuy）. The Harris score,clinical and radiological results were retrospectively analyzed. Results All patients were followed up for 48 to 78 months（mean.. 61 months）. The average Harris score increased from 38 （ 25-46） to 87 （76-94）. All prostheses were initially stable, and no infection, dislocation or complication like deep venous thrombosis was observed after revision. All patients were able to walk without assistance; two of them had minor claudication; radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence. Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation, with good short-and medium-term clinical results for revision in elderly patients with less severe hone defects than those in Paprosky Ⅳ.

关 键 词：髋关节 翻修 股骨 

分 类 号：R687.3[医药卫生—骨科学]