同期双侧人工全髋关节置换术15例

SIMULTANEOUS BILATERAL TOTAL HIP ARTHROPLASTY IN A SINGLE PROCEDURE

目的探讨同期双侧人工全髋关节置换术的疗效。方法1999年8月~2004年3月,对15例(30髋)患者行双侧全髋关节置换术。其中男11例(22髋),女4例(8髋);年龄35~70岁;病程1~50年(平均4.8年)。术前髋关节Harris评分12~45分,平均27分。其中5例采用Smith-Peterso切口,10例采用后路Morre切口。结果手术时间3h25min^5h,平均4h10min,术中输血400~2400ml,平均1160ml。15例均获随访3~35个月,平均18个月,髋关节术后Harris评分70~100分,平均86分,较术前平均提高59分(27~86分),差异有统计学意义(P<0.05)。除1例患者于术后1个月因“心肌梗死”死亡外,其余患者术后均无感染、肺栓塞、深静脉栓塞、假体松动、下沉及脱位等并发症发生。患者均能独立行走,自理生活。结论同期双侧人工全髋关节置换术是一种安全有效的手术,但在选择病例时应慎重,并须作好充分的术前准备。

Objective To study the effect of simultaneous bilateral total hip arthroplastyin a single procedure. Methods From October 1999 to March 2004, 15 patients （30 hips） underwent simultaneous sequential bilateral total hip arthroplasty （THAs） in a single procedure. Of the 15 patients, 11 were male （22 hips） and 4 were female （8 hips）. Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years （4.8 years on average）. The Harris scores of the joint function before the operation ranged from 12 to 45 points （27 points on average）. Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours （4 hours and 10 minutes on average）. The volume of blood transfusion during operation was 400 to 2 400 ml （1 160 ml on average）. All the 15 patients were followed up for 3 to 35 months （18 months on average）. The Harris scores of the joint function after the operation ranged from 70 to 100 points （86 points on average）. There was significant difference in the scores between before and after operations （P〈0. 05）. There was only 1 death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplastyin a single procedure is a safe and effective method. However, the decision of performing single stage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.