髋关节假体置换翻修75例随访

Hip replacement revision:Follow-up of 75 cases

选择1999-03/2007-12广西医科大学第一附属医院收治的髋关节假体置换失败需进行翻修治疗75例患者。对全髋置换后不久脱位的以原假体翻修6例,脱位时间较长的则更换假体翻修15例。对半髋置换失败的病例,无论何种原因,均改全髋假体翻修。翻修过程中2例患者出现骨水泥反应综合征。翻修后第2天复查血常规,患者白细胞计数普遍升高在(10.5～11.0)×109/L,术后第7～10天恢复正常。血沉轻度升高(21～30mm/h)52例,中度升高(31～45mm/h)23例,其中71例在2～4周恢复正常,4例6周恢复正常。2例出现下肢静脉血栓,肢体轻中度肿胀,经处理恢复正常。在3～72个月随访期内,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,3例出现假体松动。疗效评估标准选择美国骨科学会1968年公布的5级评定方法:以原假体翻修的6例,近期疗效优5例,良1例。更换假体翻修的69例,近期疗效优59例,良8例,差2例。翻修总优良率为97.3%。

Seventy-five cases undergoing revision following failed total hip replacement in First Hospital of Guangxi Medical University from March 1999 to December 2007 were selected. Six cases received revision with the original prosthesis （total hip replacement）, and 15 underwent another implant （including total and partial hip replacement）. During revision, 2 cases developed bone cement response syndrome, and blood routine examination showed increased white blood cell counting （10.5-11.0）× 10^9/L on the next day following revision, and restored at 7 and 10 days. Mile elevation （21-30 mm/h） of blood sedimentation was found in 52 cases and moderate elevation （31-45 mm/h） in 23 cases, of which 71 restored at 2 4 weeks, and 4 restored at 6 weeks. Two cases developed venous thrombosis in the lower limbs, and mild swelling, and restored after treatment. During 3-72 months＇ follow up, radiograph showed no prosthesis corrosion of metals or degradation, and 3 cases developed prosthesis loosening. According to the standards of American Academy of Orthopedic Surgeons in 1968, of 6 cases undergoing initial prosthesis replacement, 5 were excellent and 1 was good in a short term, and of 69 cases undergoing newly prosthesis replacement, 59 were excellent, 8 were good and 1 was poor. The total excellent and good rate was 97.3%.