人工髋关节置换术后翻修相关原因浅析

Clinical Cause Analysis of Revision Total Hip Arthroplasty

目的探讨造成人工髋关节置换术后翻修相关的主要原因。方法分析68例人工髋关节置换术后翻修相关的主要原因。结果造成早期(术后5年以内)翻修的32例中髋臼假体位置不良导致复发性脱位12例,手术调整髋臼假体位置;髋臼假体松动11例,翻修髋臼和(或)股骨假体;术后早期股骨假体周围骨折4例,行骨折复位固定;股骨头磨损髋臼3例,行全髋翻修;感染2例,行二期手术翻修。造成晚期(术后5年以上)翻修的36例中股骨头磨损髋臼13例,行全髋翻修;髋臼假体松动12例,翻修髋臼和(或)股骨假体;术后晚期股骨假体周围骨折7例,行骨折复位固定;髋臼假体位置不良导致复发性脱位4例,手术调整髋臼假体位置;行二期手术翻修。两组术前术后Harris评分比较,差异有统计学意义(P<0.05)。结论造成早期(术后5年以内)翻修主要因为髋臼假体选择、处理及安放技术不当;造成晚期(术后5年以上)主要因为无菌性松动,髋臼磨损。

Objective To explore the main cause of revision total hip arthroplasty（THA）.Methods The clinical of sixty eight patients with revision total hip arthroplasty were analyzed retrospectively.Results Thirty two cases underwent early revision in 5 years： 12 cases were with recurrent dislocation due to malposition of acetabular prosthesis;11 cases with loosening of acetabular prosthesis;4 cases with periprosthetic femoral fractures,3 cases with abrasion of the native acetabulum;and 2 cases with periprosthetic infection and received the secondary operation revision.36 cases underwent later period revise beyond 5 years： 13 cases were with abrasion of the native acetabulum;12 cases with loosening of acetabular prosthesis;7 cases with periprosthetic femoral fractures,and 4 cases with recurrent dislocation due to malposition of acetabular prosthesis.The difference of the average of Harris hip score before and after the operations had statistical significance in both gorups（P0.05）.Conclusion The main cause of early revision within 5 years is related to uncorrected insert of acetabular prosthesis,aseptic loosening,acetabular erosion and mechanical failure in the late revision.