人工关节置换后疼痛行再次全髋关节翻修41例

Revision after total hip arthroplasty in 41 patients

高州市人民医院脊柱关节外科2000-08/2006-08共收治人工髋关节及人工股骨头置换后髋关节疼痛而进行人工全髋关节翻修患者44例,获得随访41例。翻修施术者为第一作者,副主任医师,从事人工关节专业工作9年,完成人工关节置换620余例。①人工股骨头置换后疼痛患者26例,男17例,女9例;年龄67～79岁,平均72.3岁。因假体柄松动12例,髋臼磨损8例,人工股骨头脱位3例,关节周围骨化2例,假体柄断裂1例。②人工全髋关节置换后疼痛患者15例,男9例,女6例;年龄66～80岁,平均73.4岁。因假体柄松动6例,髋臼假体松动2例,髋臼假体磨损2例,人工股骨头脱位2例,切口感染1例,迟发性感染1例,假体柄断裂1例。③随访41例翻修后材料反应:4例患者出现骨水泥反应综合征,表现为急性低血压、低血氧、心律失常,均无人工关节的排斥反应。随访期内X射线片复查关节假体未见金属腐蚀现象,髋臼聚乙烯假体无降解。④随访41例翻修后宿主反应:人工全髋关节翻修后第2天复查血常规,患者白细胞计数普遍升高,术后第7天复查白细胞计数,除个别伤口感染者外绝大多数患者恢复正常。3例患者出现下肢静脉血栓。疼痛缓解率达90.2%。41例随访1～7年结果提示假体松动、髋臼磨损、人工股骨头脱位、关节周围骨化等并发症是造成人工髋关节置换后髋关节疼痛的主要原因,全髋关节翻修能明显改善疼痛状况。

Forty-four patients suffering from hip pain after the hip and femoral head replacement were treated by revision for total hip arthroplasty in Spinal and Joint Surgery of Gaozhou People＇s Hospital between August 2000 and August 2006. Forty-one patients were followed up. The surgeon, an associate chief physician, had been engaging in artificial joint field for 9 years, and performed artificial joint replacement for 620 patients. （1）There were 26 patients with pain after artificial femoral head replacement, including 17 males and 9 females with an average age of 72.3 years （range, 67-79 years）. Of the 26 patients, 12 had loosening of prosthesis stem, 8 acetabular wear, 3 dislocation of artificial femoral head, 2 ossification around the joints, and 1 periprosthetic fracture. （2）Fifteen patients suffered with pain after total hip replacement, including 9 males and 6 females with an average age of 73.4 years （range, 66-80）. Of them, there were 6 with loosening of prosthesis, 2 with loosening of acetabular prosthesis, 2 with wear of acetabular prosthesis, 2 with dislocation of artificial femoral head, 1 with infection of incision, 1 with delayed infection, and 1 with periprosthetic fracture. （3）During follow up, 4 cases developed bone cement response symptoms such as acute hypotension, hypoxemia, and arrhythmia, but no rejection induced by artificial joint was found. X-ray films showed that no metal corrosion or acetabular polyethylene prosthesis degradation occurred. （4）White blood count was generally elevated the day after revision of total hip arthroplasty, and mostly recovered 7 days after revision. Three patients had venous thrombosis of lower extremities. All 41 patients were followed up for 1-7 years, and odynolysis rate was 90.2%. The results indicate that the complications such as loosening of prosthesis, acetabular wear, dislocation of artificial femoral head, and ossification around the joints are main causes of hip pain after hip prosthesis replacement. Revision of total hip arthroplasty is an efficient method to relieve the pain.