人工髋关节翻修术80例临床分析

Clinical Analysis of Revision after Total Hip Arthroplasty in 80 Cases

【目的】回顾分析80例人工髋关节翻修术的病因,并探讨相关翻修技术。【方法】1992年6月至2005年6月共进行了80例人工髋关节翻修术,对前次手术翻修的原因进行分析并对翻修术的技术问题作了讨论。【结果】翻修原因占第一位的为假体松动、假体周围骨溶解共48例,人工股骨头引起髋臼磨损18例,医源性因素如适应证选择不当、假体位置不良、手术操作失误等共10例,术后感染4例。随访时间2-10年,平均随访3.8年,按Harris评分,优46髋,良20髋,可14髋,优良率为82.5%。【结论】引起人工髋关节置换术后翻休的主要原因是假体无菌性松动,翻修术中应合理地选择髋臼的修复、重建方法,但也应重视提高首次手术质量。

[Objective] To review and analysis the cause of revision after total hip replacement of 80 cases, and probe its correlation technique. [Methods] Eighty cases were revised after total hip replacement in our hospital from June 1992 to June 2005. The cause of revision after total hip replacement was analyzed according to the primary operation and the technique was discussed. [Results]There were 48 cases with loosening of prosthesis and erosion of the bone around the prosthesis which were the commonest reasons of revision. There were 18 cases with acetabular erosion. There were 10 cases caused by iatrogenic factors including wrong operative indications, wrong position of prosthesis and operative fault. Four cases had post-operative infection. The mean follow-up period was 3.8 years（ranged from 2 to 10 years）, Harris score were evaluated as excellent in 46 hips,good in 20 hips and fair in 14 hips, 82. 5% of all cases were excellent or good. [Conclusion] The main cause of revision after total hip replacement is sterile loosening. The methods to repair and reconstruct the acetabulum should be chosen properly, and the quality of primary operation is also very important.