人工髋关节翻修术32例临床分析

Review and analysis of revision of total hip arthroplasty in 32 patients

目的:探讨人工髋关节翻修术的临床特点和手术方式。方法:回顾性分析行人工髋关节翻修术32例患者(共34髋)的临床资料。髋臼侧:10髋直接采用纯钛螺旋臼成型,8髋采用颗粒植骨及螺旋臼成型,6髋采用颗粒植骨,髋臼支架重建髋臼骨水泥髋臼假体成型。股骨侧:10髋采用劈开股骨侧的方法取出假体并清除骨水泥,采用捆绑带固定,9髋采用远端开窗清理骨水泥植入加长柄假体,6髋取出假体植入加长柄,并视骨质缺损情况进行植骨,3髋股骨骨折采用骨夹板捆绑带固定。感染4例均采用一期彻底清创植入非骨水泥假体。结果:术后除髋臼侧进行支架重建的患者卧床1～2周,其余患者均在3d内下床活动。平均随访26个月(6～60个月),X线片显示假体周围均无新出现的透明带。结论:假体无菌性松动是人工髋关节翻修最常见的原因,术中应根据患者年龄、骨缺损的类型选择不同的手术方式和假体类型,以获得良好的手术效果。

Objective： To research the clinical characteristic of the revision of total hip replacement（IHR） and operation way. Methods： Thirty-two cases （34 hips） were revised on total hip replacement, 10 hips of hip mortar side, adopted the spiral mortar shaping of pure titanium directly, 8 hips adopted particles to plant bone and spiral mortar shaping, 6 hips adopted particles to plant the bone, the hip mortar support rebuilt hip mortar bone cement hip mortar false body shaping. Femur side 10 hips take out the hip prosthesis and remove the bone cement by splitting and opening the femur side, then restored to the throne bone block Opened to split, it was it bring regular to truss up to adopt, 9 hips turned on window clear up bone cement planted into and extended the hip prosthesis to plant, 6 hips took out hip prosthesis and extended the hip prosthesis to plant, 4 with infection adopted the first stage of plant. Results： Except for the patients who underwent acetabular reconstruction with reinforcement ring had to walk without loading on the surgery hip all the patients could take walking the help of crutches with unconstrained loading within 3 days the mean follow-up period was 20 months （6-60 months） and X-ray evaluation of the revised. Components demonstrated no evidence of loosening of subsidence and could provide evident trabecular remodeling of both the graft and the host bone. Conclusions： The most common cause of revision is loosening should choose different operation way and hip prosthesis type according to the type of flawed or damaged, patientrs age, in order to obtain the good operation result.