脑血管意外患者髋关节置换术12例分析

Experience of artificial hip joint replacement in patients following cerebrak vascular accdient(CVA)

目的 探讨脑血管意外患者行人工髋关节置换术的适应证及围手术期、术后的综合治疗。方法 分析脑血管意外患者行人工髋关节置换术 12例 ,其中男 8例 ,女 4例 ,既往有脑出血 5例 ,脑梗死 7例 ,脑血管意外病程最短 1年 ,最长 5年 ,伴肢体偏瘫 9例 ,全部患者伤前可独步或扶拐行走。手术原因是摔倒致股骨颈骨折 10例 ,股骨头缺血性坏死 1例 ,骨关节炎 1例。施行全髋关节置换术 8例 ,人工股骨头置换术 4例。结果 随访平均时间 2年 3个月 ,总满意率为 78 4 % ,术后发生并发症 5例 ,关节脱位 4例 ,髋痛 2例 ,异位骨化和假体松动各 1例。结论 ①脑血管意外患者只要机体情况好 ,肢体肌力 4级或以上 ,因髋部疾病致功能障碍者应尽早手术治疗。②术前术后要注意治疗并存病 ,改善全身状部。术后关节脱位在脑血管意外患者中发生率较高 ,值得注意。③应选用骨水泥型假体 ,行后外侧入路切口 ,术中避免广泛组织剥离 ,术后不宜过早负重下地活动 ,加强康复训练是手术成功的重要因素之一。

Aim To study the indication of hip joint replacement in CVA patients and the general treatment during,pre-and post operation.Methods 12 cases of CVA were treated by artificial hip joint replacement. 5 patients suffered from cerebral hemorrhage,7 cases cerebral infarction respectively,and 9 cases had hemiplegia.The causes of operation were femoral neck fracture in 10,avascular osteonectosis of the femoral head degenerarive osteoarthritis in 1 respectively,8 cases had total hip arthroplasty and 4 cases had femoral head replacement.Results The mean time of follow-up was 2 years and 3 months.About 78.4% of cases were satisfied.There were 5 patients with complications,including dislocation in 4 hips,pain in hip join in 2 hip,loosening of the prosthesis in 1 hip and heterotopic ossification in 1 hip. Conclusions ①The patients with hip disorders and difficulty in movement arter CVA should be treated with hip joint replacement as soon as possible,whose operative extremity had 4 degrees in muscular rone at least before operation.②It is important to treat the existing diseases before and after operation.Prosthesis dislocation occurred more frequently in CVA patients.③Generally the first choice is to use the cement prosthesis and the lateral posterior incision.With the improvement of the operative skill and the rehabilitation training,the clinical results can be much better.