生物翻修加长柄在髋关节初次翻修股骨缺损中的应用  

Application of cementless long-stem revision for femoral bone defect in first revision of hip joint

作　　者：乐国平[1] 张明[1] 周定球[1] 方怀玺[1] 王勇[1] 袁明武[1] 

机构地区：[1]广西医科大学第四附属医院关节骨病科,柳州545005

出　　处：《中华关节外科杂志（电子版）》2015年第5期589-593,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨生物型翻修加长柄治疗全髋关节置换(THA)术后股骨假体松动伴股骨骨缺损的早中期疗效。方法对21例(21髋)自2009年1月至2014年3月在广西医科大学第四附属医院关节骨病科因THA术后股骨假体松动伴股骨骨缺损的患者采用生物型翻修加长柄治疗。股骨缺损病例中的3例未予植骨,17例采用自体或同种异体颗粒骨植骨,1例自体大块髂骨结构性植骨,使用钢丝、钢缆固定。结果术后髋关节疼痛消失或明显缓解,关节功能改善。21例获随访8~55个月,平均42个月,未发现感染病例。末次随访时未发现假体周围骨折及假体远端出现新透亮带。Harris评分:术前32~38分,平均(34.9±1.8)分;术后71~89分,平均(84.8±4.0)分,手术前后Harris评分比较有统计学差异(P<0.05)。术后髋关节功能较术前明显得到改善。结论人工全髋关节翻修术中使用生物型翻修加长柄治疗股骨假体松动伴股骨骨缺损患者的早中期疗效可靠,但远期疗效有待进一步随访观察。Objective To investigate the earlyandmid-termeffects of the cementlesslong-stem revision for prosthesis loosening with femoral bone defect following total hip arthroplasty. Methods&nbsp;Twenty-one patients ( 21 hips ) of femoral prosthesis loosening with femoral bone defect after total hip arthroplasty in orthopedic department, the 4th Affiliated Hospital of Guangxi Medical University, were treated by the cementless long-stem revision.Three cases did not use bone grafting, 17 cases adopted autologous or allogeneic morselized bone grafting, and one case accepted structural autologous iliac bone grafting.All the patients underwent internal fixation with wires and cables.Results The hip pain disappeared or was relieved obviously after the surgery, and the joint functions were improved.All the cases were followed up for eight to 55 months, 42 months in average.No infection, periprosthetic fractures, or new radiolucent zone at the distal part of the prosthesis was observed at the latest follow-up. The preoperative Harris score was 32-38, (34.9 ±1.8) in average, and the postoperative Harris score was 71-89, ( 84.8 ±4.0 ) in average.The preoperative Harris score of the patients was statistically significant ( P<0.05) , and the postoperative hip function was significantly improved compared with the preoperative one.Conclusion The total hip arthroplasty revision using cementless long-stem prosthesis for the treatment of femoral prosthesis loosening with femoral bone defects shows reliable early and mid-term curative effects , but the long-term effect needs further follow-up observation.

关 键 词：再手术 髋 生物假体 

分 类 号：R687.4[医药卫生—骨科学]