翻修型加长柄在人工全髋关节翻修术中的应用

Application of revisable long-stem femoral component in revision of total hip arthroplasty

目的探讨采用翻修型股骨加长柄假体治疗股骨侧假体松动伴有骨缺损的方法和疗效。方法2001年1月-2005年4月，采用翻修型加长柄假体翻修手术16例17髋，其中男9例，女7例，年龄35—71岁，平均54．6岁。股骨近端腔隙性骨缺损12髋，节段性骨缺损5髋。对于骨缺损采用颗粒骨移植（自体／同种异体），自体大块髂骨结构性植骨，钢丝或钛质捆绑带固定。初次手术原因：股骨颈骨折11例11髋，股骨头无菌型坏死2例3髋，类风湿性关节炎1例1髋，陈旧性结核1例1髋。术前Harris评分：10—72分，平均41．1分。结果采用翻修型加长柄假体对16例患者的17个髋关节进行了翻修手术，无感染。随访16例，随访时间10个月-5年，平均3年6个月，Harris评分平均86分。放射学检查显示部分患者假体周围存在骨质重建。随访时X线片与术后当时比较，未发现假体周围有新出现透亮带的患者。结论采用翻修型股骨加长柄假体治疗股骨侧假体松动伴有骨缺损的方法近期疗效肯定，远期疗效有待进一步观察。

Objective To research the treatment of prostheses loosen with defects of femur using revisable long-stem femoral component prostheses. Methods Retrospective study was done on revisable long-stem femoral component in revision of total hip arthroplasty in 17cases of 16 patients who were admitted from Janurary 2001 to April 2005. There were 9 males and 7 females,ranging from 35 to 71 of age（ mean 54.6 years）. Among them,12 cases were with cative defects of the proximal femur,5 cases with segment defects. The reparation of bone defects in the revision surgery of total hip arthroplasty included morselized bone （autogenous/allogenic）graft, autogenous iliac bone graft ,fixation with steel wire or titanium band. The reasons of primary arthroplasty ：fracture of femoral neck in 10 cases of 10 patients ,ischemic necrosis of femoral head in 3 cases of 2 patients,rheumatoid arthritis in 1 case of 1 patient,old hip joint tuberculosis in 1 case of 1 patient. According to Harris hip scoring system, preoperative average of Harris score was 41.1, ranging from 10 to 72. Results By using revisable long-stem femoral component prostheses 17 hip joints of 16 patients were revised without infection. The average of Harris score obviously improved to 86 in 16 cases which were followed up from 10 months to 60 months （ mean 42 months ）. Roentgenograms presented bone reconstructed and bone density increased around periprostheses in a few eases. There were no significant differences about periprosthetic lucencies between follow-up and postoperation by roentgenograms. Conclusion It is effective to use revisable long-stem femoral component prostheses to treat prostheses loose with defects of femur in short terms. The evaluation of longterm treatment needs further observation.