86例(95髋)复杂人工全髋关节置换术分析

An analysis of 86 case (95 hips) of complex total hip arthroplasty

[目的]探讨复杂人工全髋置换术中髋的重建及假体置换的方法。[方法]自1995年2月～2007年6月共有86例95髋不同病因的复杂髋关节病变行全髋关节置换术,采用术前充分准备、评估、模拟,术中依具体情况,以恢复髋部的生理与正常解剖为原则,进行人工全髋置换。[结果]术后81例获得随访,随访时间6个月～10年,平均3.5年,髋关节功能按Harris评分标准,术前评分35～50分,平均42.1分,术后评分70～90分,平均82.3分。术前双下肢严重不等长2例,1例为6cm,另1例为12cm,术后下肢不等长分别为2cm、5cm。本组81例病例下肢不等长最少1cm,最多12cm,平均4cm,术后病例下肢不等长平均为1.5cm。手术切口愈合不良2例,股骨上段劈裂3例,假体脱位1例,坐骨神经损伤2例,深静脉栓塞2例。[结论]在复杂人工全髋关节置换术中,因其局部解剖结构变化大,重建与恢复髋部正常生理结构为其重点与难点,术前充分评估、模拟,术中依具体情况,最大限度地恢复髋部生理解剖,都能获得较好的临床结果。

[ Objective] To search for a good way for complex total hip arthroplasty （THA） and hip reconstruction. [ Method] From February 1995 to June 2007 ,THA was done 95 hips in 86 patients with good preoperative preparation, full evaluatibn and complete simulation the details occurring at operation. [ Result] Eighty one patients were followed up from 6 months to 10 years（ average 3.5 years）. All patients were measured by Harris score. The preoperative Harris score in the patients ranged from 35 to 50 （ average 42.1 ）. The postperative score ranged from 70 to 90 （ average 82.3 ）. Leg length discrepancy ranged from 1 to 12 cm preoperative. （average 4 cm） ,but from 0 to 5 cm postperative（ average 1.5 cm）. Two with serious leg length discrepancy,one is 6 cm, the other is 12 cm,afier the operation,one is 2 cm, the other is 5 cm. Two had poor incision healing, upper femur split occurred in 3, one with hip prothesis dislocate, nerve injury happened in 2 and two had venous embolism. [ Conclusion] Anatomic structure in complex total hip arthroplasty changes so much that it is hard to rebuild and replace a normal hip anatomic structure. Excellent clinical outcome can be achieved with full preparation and evaluation before operation and careful management at opertation.