髋关节置换后的假体内分离并发症  

Complications of intra-prosthetic dissociation after hip arthroplasty

作　　者：廖启宇 茹江英 Liao Qiyu;Ru Jiangying(Department of Orthopedics,Affiliated Qingyuan Hospital,Guangzhou Medical University,Qingyuan People’s Hospital,Qingyuan 511518,Guangdong Province,China)

机构地区：[1]广州医科大学附属清远医院(清远市人民医院)骨关节科,广东省清远市511518

出　　处：《中国组织工程研究》2025年第33期7241-7249,共9页Chinese Journal of Tissue Engineering Research

摘　　要：背景:应用于髋关节置换术中组配型假体最大的优势在于,可赋予手术极大的灵活性,个体化满足不同患者的需求,并降低假体翻修的概率;即使翻修也可使手术化繁为简,减少骨质的破坏和流失,但其术后可能发生假体内分离的并发症,目前仍是临床上一个不可忽视的重要问题,一旦发生可能带来灾难性的后果。因此,全面认识该并发症的流行病学特点、影像学判读、发生机制及处理方法等内容,对关节外科医生制定相应科学、合理的防治策略至关重要。目的:综述髋关节置换后发生假体内分离并发症的相关研究进展。方法:通过万方和PubMed数据库检索1978-01-01/2024-08-31发表关于髋关节置换后发生假体内分离并发症的研究原著、综述、述评、病例报告、荟萃分析,通过将文献汇总、分析,对髋关节置换后发生假体内分离并发症的流行病学特点、影像学判读、发生机制及治疗策略等方面做一综述。结果与结论:①假体内分离是一种相对少见的并发症;对于活动量较大的中年患者、超重或术前诊断为骨关节炎的患者,在髋关节置换术后早期发生该并发症的风险可能更大;②尽管X射线片或超声影像下的特有征象有助于诊断假体内分离,但MRI和CT在诊断聚乙烯衬垫分离方面被认为更具价值;③假体内分离发生的原因可能与假体内撞击、假体自身因素、假体位置安装不当、医源性分离等因素有关;④假体内分离的治疗策略应权衡假体内分离的类型、患者的身体状况及合并症等综合因素而定。BACKGROUND:The modular prosthesis applied in hip arthroplasty has the greatest advantages of making operations more flexible,individually meeting the needs of different patients,and reducing the chance of prosthesis revision.Even in the case of revision surgery,the procedure can be simplified,minimizing bone destruction and loss.However,the possible complication of intra-prosthetic dissociation after operation is still an important issue that cannot be ignored in clinical practice,which may bring disastrous consequences once it occurs.Therefore,having a comprehensive understanding of the epidemiological characteristics,imaging interpretation,mechanism and treatment of this complication is of great importance for joint surgeons to develop appropriate scientific and reasonable prevention and treatment strategies.OBJECTIVE:To review the research progress on the complication of intra-prosthetic dissociation after hip arthroplasty.METHODS:The WanFang and PubMed databases were retrieved for original research,reviews,comments,case reports,and meta-analyses published from January 1,1978 to August 31,2024 on the complications of intra-prosthesis separation after hip replacement.The epidemiological characteristics,imaging interpretation,occurrence mechanism,and treatment strategies of intra-prosthesis separation complications after hip arthroplasty were reviewed by summarizing and analyzing the literature.RESULTS AND CONCLUSION:(1)Intra-prosthetic dissociation is a comparatively uncommon complication.This complication may pose a higher risk in the early postoperative period for patients who are middle-aged with higher activity level,overweight or preoperatively diagnosed with osteoarthritis.(2)Although specific signs under X-ray or ultrasound imaging can facilitate the diagnosis of intra-prosthetic dissociation,MRI and CT are deemed more valuable in diagnosing polyethylene liners dissociation.(3)The cause of intra-prosthetic dissociation may be related to factors such as intra-prosthetic impingement,prosthesis-related fact

关 键 词：假体内分离 髋关节置换 发生机制 治疗策略 骨科植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4