年轻患者初次髋关节置换术后关节翻修的原因分析

Factors analysis on revision surgery after total hip replacement in young patients

目的分析40岁之前接受初次全髋置换的患者行髋关节翻修的主要原因,并与老年患者(年龄≥60岁)的翻修原因对比。方法回顾性分析2005年1月至2020年10月在南昌市洪都中医院接受髋关节翻修术的156例(年轻组76例,老年组80例)患者(188例髋关节),明确患者行髋关节翻修的原因、两次手术间隔的时间和需要翻修的部分是否有区别。卡方检验分析翻修部分与初始固定方式(骨水泥或非骨水泥固定)的关系。结果年轻患者初次置换术后至翻修手术的平均间隔时间为(11±5)年,行初次全髋置换最常见的病因分别是:股骨头缺血性坏死、发育性髋关节发育不良、创伤性关节炎和青少年特发性关节炎。年轻患者行髋关节翻修的主要原因是:髋臼假体松动(29.4%)、聚乙烯内衬磨损(20.6%)和股骨假体松动(18.6%)。老年患者髋关节翻修的最常见的原因分别是:术后脱位(26.7%)、感染(20.9%)、髋臼假体松动(16.3%)。在年轻患者中,假体松动需翻修的部分与初始固定方式的差异无统计学意义(χ^(2)=0.146,P>0.05)。结论髋臼假体松动、聚乙烯磨损和股骨假体松动是年轻患者翻修的常见原因;与高龄患者翻修原因相比,术后脱位和感染的发生率较低。

Objective To analyze the main causess for hip revision in patients who have primary total hip replacement(THA)under 40 years old,and to compare with the elderly(age≥60 years).Methods A retrospective analysis was conducted on 156 patients(76 in the young group and 80 in the elderly group)who underwent revision hip arthroplasty at Nanchang Hongdu Hospital of Traditional Chinese Medicine from January 2005 to October 2020.Clinical data of 188 hip joints(102 hips in the young group and 86 hips in the elderly group)were collected to clarify the reasons for hip revision,the time between two operations,and the difference in the revision part.Chi-square test was applied to analyze the relationship between revision parts and the fixation methods of primary THA(bone cement or cementless prostheses).Results The average interval between primary THA and revision surgery in the young group was(11±5)years.The most common causes of primary THA were:avascular necrosis of the femoral head,developmental dysplasia of the hip,traumatic arthritis and juvenile idiopathic arthritis.The causes for hip revision in the young group were:acetabular prosthesis loosening(29.4%),polyethylene liner wear(20.6%)and femoral prosthesis loosening(18.6%).The most common reasons for revision in the elderly group were:postoperative dislocation(26.7%),infection(20.9%),and loosening of the acetabular prosthesis(16.3%).In the young group,the revision part of prosthesis was not related to the fixation method in primary THA(χ^(2)=0.146,P>0.05).Conclusions After primary THA,acetabular prosthesis loosening,polyethylene wear and femoral prosthesis loosening are the common causes of revision in young patients;while the incidences of postoperative dislocation and infection are lower in the youth than that in the elderly.