人工髋关节置换术后5年内翻修的原因分析及处理方法

Clinical analysis of revision after primary hip replacement in the early stage

目的 探讨初次髋关节置换术后早期翻修的原因和防治方法.方法 回顾性分析2002年1月至2007年6月55例行人工髋关节翻修术患者的资料,其中术后5年内（含5年）翻修11例,翻修原因及翻修方式为：髋臼假体位置不良导致复发性脱位2例,手术调整髋臼假体位置;髋臼假体松动5例,翻修髋臼和（或）股骨假体;术后早期股骨假体周围骨折2例,行骨折复位固定;股骨头磨损髋臼1例,行全髋翻修;感染1例,行二期手术翻修.术前和术后随访采用Harris评分评估髋关节功能.术前Harris评分平均46分（28～62分）.结果 本组随访时间16～76个月,平均36个月.术后Harris评分提高至平均86分（75～96分）.术后出现并发症2例：1例术后局部血肿形成,4周后需再次手术清理血肿;1例术后关节不稳,经适当牵引制动后关节不稳定现象消失.无感染、深静脉血栓、主要血管和神经损伤等并发症发生.结论 初次髋关节置换早期翻修主要原因与髋臼假体处理、假体选择和安放技术不当有关,因此提高髋臼假体安放的手术技术有助于改善人工髋关节的疗效.

Objectives To analyze the reason of revisions no more than S years after primary hip replacement,and to discuss the methods how to prevent and manage. Methods Retrospectively review 11 cases with revision no more than 5 years after primary total hip replacement from January 2002 to June 2007. The reasons for revision were as follows： 2 cases were recurrent dislocation due to malposition of acetabular prosthesis; 5 cases were loosening of acetabular prosthesis; 1 case was abrasion of the native acetabulum by bipolar femoral head; 2 cases were periprosthetic femoral fractures and 1 case was periprosthetic infection. The average follow-up time was 36 months. Each patient was assessed according to Harris hip score. The revision procedures including liner only, acetabular prosthesis only, or both acetabular prosthesis and femoral prosthesis depending on the reasons for revision, two-stage revision was performed on 1 case with periprosthetic infection. Results The average of Harris hip score was increased from 46 （28 to 62 ） preoperatively to 86（75 to 96） at follow up. The complication occurred in 2 cases; one was postoperative haematoma formation who was performed further surgery for clearance of haematoma, another was slight instability of the hip joint who was accepted skin traction for 3 weeks. Conclusions The main reason for revision after primary total hip replacement is related to uncorrected insert of acetabular prosthesis. Improving surgical technique of insert of acetabular prosthesis is important in primary total hip replacement.