93例同期双侧人工全髋关节置换术回顾性分析

Retrospective analysis on simultaneous bilateral total hip arthoplasty in 93 patients

目的回顾性分析93例双侧同期人工全髋关节置换术（total hip arthroplasty，THA）中及术后并发症、术后功能恢复情况。方法1999年1月-2009年1月，总共随访到93例（186髋）患者行同期双侧THA，其中男70例，女23例；年龄25～65岁，平均41．8岁。双侧股骨头缺m坏死（ONFH）48例，发育性髋关节脱位（DDH）合并骨关节炎26例，双侧类风湿性髋关节炎（RA）11例，强直性脊柱炎（As）8例。统计所有患者术中失血量，术前及末次随访Harris评分，术中及术后并发症。结果93例患者平均随访时间65个月（12～118个月）。其中1例（1髋）术中发生股骨骨折，1例（1髋）出院后6个月发生感染。Harris评分从术前的（36．7±6．1）分增加到末次随访的（91．2±6．2）分。92例患者疼痛消失，x线评估无假体松动；1例（1髋）术后49个月发生髋臼侧假体松动行翻修术。结论严格掌握手术适应证，合理选择并按标准程序安装假体，注重围术期处理和康复训练，行同期双侧THA是双侧髋关节疾病既安全又有效的选择。

Objective To retrospectively study the perioperative complications and postoperative function recovecy of 93 patients treated with simultaneous bilateral total hip arthroplasty （THA）. Methods A total of 93 patients （ 186 hips） undergone simultaneous bilateral THA from Januacy 1999 to January 2009 in our hospital were involved in this study. There were 70 males and 23 females （ at age range of 25-65 years, average 41.8 years）. The preoperative diagnosis included bilateral avascular necrosis of femoral head in 48 patients, rheumatoid arthritis in 11, developmental dysplasia of the hip in 26 and ankylosing spondylitis in 8. The intraoperative blood loss, Harris scores before operation and at final follow- up as well as perioperative complications were analyzed. Results All the patients were followed up for average 65 months （ 12-118 months） , which showed femur fracture in one patient and infection six months after discharge in one patient. The Harris score was increased from （36.7 -＋ 6.1 ） points preoperatively to （91.2 ＋ 6.2） points at the final follow-up. Hip pain disappeared in 92 patients after operatiml and radio- graph showed no loosening. Aetebular loosening occurred in one patient 49 months after operation and was revised accordingly. Conclusion Under strict control of operation indications, suitable choice and implantation of the prosthesis and emphasis on perioperative management and postoperative rehabilitation, simultaneous bilateral THA is a safe and effective choice for bilateral hip diseases.