髋关节翻修术失败原因分析

Analysis of the failure mechanisms of the revision hip arthroplasties

目的对髋关节翻修术失败原因以及与失败相关的手术技术、假体材料和患者相关易感因素对于不同失败原因的影响进行分析。方法回顾性分析1995年11月至2008年6月30例髋关节翻修术失败（26例为初次翻修术失败，4例为再次翻修术失败）患者的临床资料。其中男性18例，女性12例；均为单侧病例。患者初次置换平均年龄49岁（25—68岁），初次翻修平均年龄53岁（27～72岁），平均间隔时间43．8个月（0～156个月）。对比分析髋关节翻修术与初次置换的失败原因，同时对初次翻修年龄以及翻修失败时间进行分组，比较各组间相关危险因素的统计学意义。结果以再次翻修或假体取出作为终止点，30例翻修术失败原因包括：无菌性松动22例（73．3％）、感染性松动4例（13．3％）、假体周围骨折3例（其中1例合并假体柄断裂）（10．0％）以及假体不稳定1例（3．3％）。患者行最后一次翻修或假体取出平均年龄58岁（38～77岁），距离上一次翻修平均间隔78．8个月（1～216个月）。初次翻修时高龄组（60岁以上，n=12）翻修失败时间显著低于低龄组（60岁以下，n=18）（P〈0．01）。结论未能获得翻修假体的有效固定与感染复发是全髋关节翻修术失败的主要原因，关节重建理念的局限与手术技术的缺陷是导致翻修失败的重要因素。

Objective To investigate the failure mechanisms of revision hip arthroplastics and evaluate the effects of surgical technique, prosthesis design and patient-related risk factors on different failure mechanisms. Methods A review of all revision hip arthroplasties from November 1995 to June 2008 identified 30 patients who underwent 30 revisions with 18 males and 12 females. The overall mean age for primary arthroplasties was 49 years （range 25-68 years） and 53 years （range 27-72 years） for index revision arthroplasties and the average interval between these two operations was 43.8 months （0-156 months）. The failure mechanisms of index revision arthroplasties and primary arthroplasties were assessed and compared. Direct comparisons were made of data for the different age categories in terms of time to failures and reasons for failures. Results Regarding rerevision or prosthesis removal as the end point of the study, the reasons for 30 revision arthroplasties were aseptic loosening in 22 hips （73.3%）, infection in 4 hips （ 13.3% ）, periprosthetic fracture in 3 hips and instability in 1 hip （3.3%）. The overall mean age for last arthroplasties or prosthesis removal was 58 years （range 38-77 years） with an average interval of 78.8 months （range 1- 216 months） from previous revision arthroplasties. The mean time to failure for patients above 60 years of age was significantly shorter than patients below 60 years of age （ P 〈 0. 01 ）. Conclusion The majority of failure mechanisms of revision hip arthroplasties are ineffective fixation of revisional implants and recurrence of local infection, which reveals the limitations to joint reconstruction philosophy and surgical technique.