31例人工髋关节翻修的临床分析

Primary revision total hip replacement for failed hip arthroplasty in 31 cases

目的探讨初次人工髋关节置换后翻修的原因。方法对31例患者行全髋关节翻修术,对髋臼或股骨缺损者进行修复重建。通过术前X线片和术中所见,推测翻修原因。结果31例患者中共有30例得到随访,随访时间为6～36月,平均18.7月。Harris评分由术前的平均(32.56±17.31)分升高至术后平均(75.40±12.52)分。术后所有患者双下肢均恢复或保持等长,髋关节疼痛缓解。并发症为术中发生股骨骨折1例,无1例发生感染或髋关节脱位。结论引起人工髋关节置换术后翻修的主要原因是无菌性假体松动。翻修术中应合理地选择髋臼或股骨缺损的修复与重建方法,同时也应重视提高初次手术质量。

Objective To study the reasons for revision after primary total hip replacement. Methods Thirty-one cases of primary revision total hip replacement were studied. Defect in the cup or femur was reconstructed. The reasons for revision were investigated by pre-revision X-rays and display in revision. Results All cases were aseptic loosening but one infective loosening. Thirty patients were followed up for 6 to 36 months （ average： 18.7 months）. Harris＇ score rose from 32.56 ± 17.31 points preoperatively to 75.40 ±12.52 points postoperatively. All cases remained the same length of lower limbs and pains of hip joint were alleviated. There was no hip joint infection or dislocation but 1 femoral fracture in operation. Conclusions Terminal loosening is the main reason for revision. Proper technology should be chosen for reparation and reconstruction of the cup or the femur. Much attention should be paid to the quality of primary total hip replacement.