单纯聚乙烯内衬更换在髋关节翻修手术中的应用

Simple polyethylene liner exchange in hip revision

目的探讨聚乙烯内衬磨损而髋臼金属杯仍然固定良好者进行单纯髋臼内衬更换的技术和疗效。方法瑞金医院在2003年2月至2007年3月期间,对16例HGⅡ型髋关节进行单纯内衬翻修手术,患者平均年龄63岁(51～82岁),距离初次手术时间平均6.2年(3～8年)。5例出现髋臼内衬脱位,3例出现髋臼金属假体周围骨吸收。术前Harris评分81.7分(56～91分)。所有患者术中取出磨损髋臼内衬后,清除髋臼内肉芽组织后,用骨水泥固定新的聚乙烯假体。3例假体周围骨吸收患者通过金属假体螺钉孔对缺损区域进行了异体骨打压植骨。结果16例髋关节术后随访2～6年,X线检查聚乙烯-骨水泥-金属杯界面没有松动迹象。3例髋臼金属杯周围植骨患者植骨愈合。随访中未发现感染及髋关节脱位。髋关节Harris评分87.6分(76～92分)。结论单纯聚乙烯内衬翻修具有手术操作简单、避免了金属杯取出继发髋臼骨缺损的优点。术后随访显示患者功能恢复良好、聚乙烯假体固定牢固。

Objective The purpose of this paper was to evaluate the surgical technique and the follow-up result of simple polyethylene liner exchange in well fixed metal shell.Methods Between Feburary 2003 to mar March 2007, 16 hips with a preexisting Harris-Galant Ⅱ acetabular socket that had been in situ for an average of 6.2 years （3-8 years） were revised with cementing and new polyethylene was inserted into a well fixed metal shell. Mean patient age was 63 years （51-82 years）. Five hips presented a dislodgment of polyethylene liner and three hips who had osteolysis around the prosthesis component was performed a bone graft through the metal shell holes. Preoperative evaluation of Harris hip score was 81.7 （range 56-91）.Results 16 patients were followed up for 2-6 years, all cases did not present polyethylene-cement-metal shell interface loosening in radiographic evaluation. 3 cases with allograft bone healing was found around the acetabular socket in three patients with allograft. No postoperative infection and dislocation was found in follow-up. The evaluation of Harris Score was 87.6 （range 76-92）.Conclusions Simple polyethylene liner exchange is a safe and useful technique in patients with a stable meta shell, this technique preserves acetabular bone stock and permits a well fixation of new polyethylene insert.