同期髋膝多关节置换的临床应用

Clinical application of same period hip knee multi-joint replacement

目的探讨同期多关节置换术治疗下肢多关节严重病变畸形的经验。方法对59例下肢多关节严重畸形患者,行同期一次双侧全髋关节置换16例,同期分次双侧全髋关节置换(两次手术间隔一周左右)12例,同期一次同侧髋膝关节置换3例,同期一次双侧全膝关节置换15例,同期分次双膝关节置换13例,共118个关节。结果经6～60个月随访复查,关节疼痛缓解,关节活动功能满意,全部病例均可独立或扶拐步行活动,生活均可自理。术前髋关节Harris评分平均38分(15～56分),膝关节HSS评分平均42分(20～58);术后髋关节Har-ris评分平均86分(69～95分),膝关节HSS评分平均91分(76～97)。结论下肢多关节病变的同期双髋、双膝或同侧髋膝关节置换术,对于严重的下肢多发畸形的治疗,具有省时、缩短康复周期、见效快等优点。但难度大,应严格掌握适应证。

Objective To explore the experience of treatment of lower limb multi-joints severe malformation by same period multi-joints replacement.Methods To 59 cases with lower limb multi-joints severe malformation,conduct same period one time bilateral total hip replacement of 16 cases,same period more than one time bilateral total hip replacement on 12 cases,same period one time ipsilateral hip knee replacement on 3 cases,same period one time bilateral total knee replacement on 15 cases,same period more than one time bilateral total knee replacement on 13 cases,total 118 joints.Results After 6-60 months follow-up review,joints pain were relieved,joint activities function satisfied.All patients were independently or helped activities.Preoperative hip Harris score is 38 on average,knee HSS score is 42 on average.Postoperative hip Harris score is 86 on average,knee HSS score is 91 on average.Conclusions Treatment of lower limb multi-joints by same period multi-joints replacement is time-saving,shorten the cycle,rapid recovery,etc,but it is so difficult,so we should master the indications strictly.