全髋关节翻修术(48例50髋随诊分析)

Revision of total hip replacement

目的评价人工全髋关节翻修术临床效果。方法自1984年1月～2006年4月,56例58髋行髋关节翻修术,男22例,女34例,年龄36～73岁,平均63岁。初次人工髋关节置换前诊断为股骨颈骨折28例,股骨头缺血坏死18例,髋关节发育不良骨关节炎9例,强直性脊柱炎1例。初次行股骨头置换术9例,其中骨水泥2例,生物型固定7例。全髋关节置换47例49髋。其中骨水泥30髋,生物型固定19髋。术后早期脱位2例,16髋因髋关节严重疼痛,45例47髋因无菌性松动行全关节翻修术。翻修手术中28髋行髋臼植骨,其中自体碎屑植骨17例18髋。自体碎骨屑加异体大块植骨10例。结果资料完整48例50髋获得随访,最长20年,最短4个月,平均随访时间为5年。经随访,患者髋关节基本无疼痛,X线片显示髋臼和股骨柄假体位置满意,无松动和感染征象,髋臼植骨后愈合良好。4例股骨柄假体正位X线片仅1区出现约1mm宽的透亮带,临床检查无松动迹象。Harris评分由术前的平均41.3分(10～70分)提高到术后的平均80.4分(55～97分)。结论全髋关节翻修手术的病例经随访,临床达到满意效果。

Objective To evaluate the clinical results of revision of hip replacements. Methods Revision operation of 58 hips in 56 patients was performed from January 1984 to April 2006. There were 22 males and 34 females ageing from 36 to 73 years with an average of 63 years. The primary diagnosis consisted of femoral neck fracture in 28, aseptic femoral head necrosis in 18, osteoarthrosis of hip dysplasia in 9, ankylosing spondylitis in 1. The primary operation included femoral head replacement in 9 （ cemented in 2, noncemented in 7） and total hip replacement in 47 （49 hips） （ cemented in 30 hips, noncemented in 19 hips ）, The complication of primary operation included dislocation of the hip replacement in 2, The causes of revision were pain for 16 hips and definite aseptic loosening for 45 （47 hips）. Bone defect ofacetabular in revision of hip replacement were used bone grafts in 28 hips （mainly cancellous bone grafts in 17 （18 hips）, auto/allograft in 10）. Results All the 48 patients （51 hips ） were followed up. The follow up time ranged from 4 months to 20 years with an average of 5 years. 48 patients were free from pain and satisfied with the result of operation. Radioluscent line ofacetabula component and radiographic subsidence of stem were not found in any of the hip joint. Bone grafts were healed. The Harris hip score increased from preoperative 41.3 points （10-70 points） to postoperative 80.4 points （50-97 points） . Radiolucency of 1 mm width was seen in 4 femoral stems with no clinical loosening occurrence. Conclusion The clinical results showed that the revision of hip replacement is proved to be suitable.