PaproskyⅠ~Ⅲ型股骨缺损患者SL-PLUS MIA柄人工髋关节翻修的中远期疗效  

Medium-and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky typeⅠ-Ⅲfemoral bone defect

作　　者：努尔艾力江·玉山 李亦丞 郭晓斌 吾湖孜·吾拉木[1] 赵旭军 徐志勇 张晓岗[1] 曹力[1] Nuerailijiang·Yushan;LI Yicheng;GUO Xiaobin;Wuhuzi·Wulamu;ZHAO Xujun;XU Zhiyong;ZHANG Xiaogang;CAO Li(Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830054,P.R.China;Department of Orthopedics,People’s Hospital of Shache County,Kashi Xinjiang,844799,P.R.China)

机构地区：[1]新疆医科大学第一附属医院骨科,乌鲁木齐830054 [2]莎车县人民医院骨科,新疆喀什844799

出　　处：《中国修复重建外科杂志》2024年第7期842-848,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：新疆维吾尔自治区科技计划重大专项项目(2022A03011);新疆维吾尔自治区科学技术厅科技创新团队项目(2023TSYCTD0014);新疆维吾尔自治区自然科学基金(2023D01E11)。

摘　　要：目的探讨PaproskyⅠ~Ⅲ型股骨缺损患者采用SL-PLUS MIA柄行人工髋关节翻修的中远期疗效。方法回顾性分析2012年6月—2018年12月采用SL-PLUS MIA柄行人工髋关节翻修的44例PaproskyⅠ~Ⅲ型股骨缺损患者临床资料。其中男28例,女16例;年龄31~76岁,平均57.7岁。翻修原因:假体无菌性松动27例,关节假体周围感染17例。髋关节Harris评分假体无菌性松动患者为54(48,60)分、感染患者为43(37,52)分。股骨缺损Paprosky分型:Ⅰ型32例,Ⅱ型9例,ⅢA型2例,ⅢB型1例。记录手术时间、术中输血量。术后定期随访,完成髋关节功能Harris评分及X线片评估、股骨柄生存率分析,以及观察手术相关并发症发生情况。结果感染患者手术时间95~215 min,平均125.0 min;术中输血量400~1800 mL,平均790.0 mL。假体无菌性松动患者手术时间70~200 min,平均121.0 min;术中输血量400~1400 mL,平均721.7 mL。患者术后均获随访,随访时间5.3~10.0年,平均7.4年。末次随访时,髋关节Harris评分假体无菌性松动患者为88(85,90)分、感染患者为85(80,88)分,均较术前提高(P<0.05)。影像学复查示,25例新植入股骨柄远端未越过原柄末端,所有股骨柄均获得骨性固定。2例出现股骨柄下沉,1例股骨柄近端外侧出现透亮线。以假体无菌性松动定义终点事件,股骨柄10年生存率为100%;以任意原因导致治疗失败为终点事件,假体生存时间为(111.70±3.66)个月,7年生存率为95.5%;感染患者7年生存率为94.1%,假体无菌性松动患者为96.3%。术后4例患者发生并发症,其中假体相关并发症2例,1例假体无菌性松动、1例关节假体周围感染复发。结论PaproskyⅠ~Ⅲ型股骨缺损患者采用SL-PLUS MIA柄行人工髋关节翻修具有手术操作简便、术后并发症少等优势,中远期疗效可靠。Objective To investigate the medium-and long-term effectiveness of hip revision with SL-PLUS MIA stem in patients with Paprosky typeⅠ-Ⅲfemoral bone defect.Methods Between June 2012 and December 2018,44 patients with Paprosky typeⅠ-Ⅲfemoral bone defect received hip revision using SL-PLUS MIA stem.There were 28 males and 16 females,with an average age of 57.7 years(range,31-76 years).Indications for revision comprised aseptic loosening(27 cases)and periprosthetic joint infection(17 cases).The Harris hip scores were 54(48,60)and 43(37,52)in patients with aseptic loosening and periprosthetic joint infection,respectively.The preoperative femoral bone defects were identified as Paprosky typeⅠin 32 cases,typeⅡin 9 cases,typeⅢA in 2 cases,and typeⅢB in 1 case.Operation time and intraoperative blood transfusion volume were recorded.During follow-up after operation,the hip joint function were evaluated by Harris hip score and X-ray films,the femoral stem survival was analyzed,and the surgical related complications were recorded.Results The operation time of infected patients was 95-215 minutes,with an average of 125.0 minutes.The intraoperative blood transfusion volume was 400-1800 mL,with an average of 790.0 mL.The operation time of patients with aseptic loosening was 70-200 minutes,with an average of 121.0 minutes.The intraoperative blood transfusion volume was 400-1400 mL,with an average of 721.7 mL.All patients were followed up 5.3-10.0 years(mean,7.4 years).At last follow-up,the Harris hip scores were 88(85,90)and 85(80,88)in patients with aseptic loosening and periprosthetic joint infection,respectively,both of which were significantly higher than those before operation(P<0.05).Radiological examination results showed that the distal end of the newly implanted femoral stem did not cross the distal end of the original prosthesis in 25 cases,and all femoral stems obtained bone fixation.Two cases experienced femoral stem subsidence and 1 case had a translucent line on the lateral side of the proximal femo

关 键 词：人工髋关节翻修 SL-PLUS MIA柄 股骨缺损 中远期疗效 

分 类 号：R687.4[医药卫生—骨科学]