长期透析患者髋关节置换手术疗效及文献分析

Effects of hip arthroplasty in long-term dialysis patients and literature analysis

目的探讨长期透析患者髋关节置换术手术疗效及注意事项。方法对本中心5例（6髋）终末期肾病长期透析患者行髋关节置换的手术疗效进行回顾分析。5例患者，股骨颈骨折3例、股骨头坏死1例、髋骨关节炎1例，平均年龄42．8（18～57）岁。3例行全髋关节置换，2例行股骨头置换，采用HHS评分系统对髋关节疼痛、功能情况进行评价。另外，计算机检索Pubmed、Medline、Embase、万方数据库、中国生物医学文献数据库、中文科技期刊数据库近10年（2000～2012）公开发表的文献，同时配合手工检索已发表的骨科论文，并查阅相关文章所附的参考文献。对所纳入的文献研究进行分析讨论。结果随访时间平均26．8（8～45）个月，术后无病例死亡，6个髋关节均无感染及松动发生。HHS评分由术前平均24．6（4～62）分增加到术后平均84．8f80～90）分，患者对功能及关节的稳定性满意。共有10篇文献描述了终末期肾病长期透析患者关节置换的手术方式、假体类型、围手术期处理、疗效及并发症等。结论本中心长期透析患者髋关节置换术的近期随访结果满意，结合文献研究，选择合理的手术方式、适当的假体、围手术期处理和术后。肾病专家协助．长期透析患者髋关节置换术可以获得较好的近期结果。

Objective To investigate the effects and matters needing attention of hip arthroplasty in long- term dialysis patients. Methods 5 long-term dialysis patients （ 6 hips ） with end-stage renal disease underwent hip arthroplasty in our center, and the surgical effects were retrospectively analyzed. Among them, there were 3 cases of femoral neck fractures, 1 case of osteonecrosis of the femoral head and 1 case of hip osteoarthritis, with a mean age of 42.8 years old （ range; 18-57 years ）. 3 patients underwent total hip arthroplasty （ THA ）, and 2 patients underwent femoral head replacement （ FHR ）. The hip pain and function of all patients were evaluated by the Harris Hip Score （ HHS ） system. Otherwise, Pubmed, Medline, Embase, Wanfang Database, Chinese Biomedical Literature Database （ CBM ） and Chinese Science ＆ Technology Journal Database were searched for related articles published in the past 13 years （ 2000-2012 ）. At the same time, published orthopedic papers were found by manual searching, and attached references were consulted. And then the literatures included were analyzed and discussed. Results The mean follow-up period was 26.8 months （ range; 8-45 months ）. There was no death case postoperatively. No infection or prosthetic loosening was developed in all 6 hips. The average HHS was increased from 24.6 points （ range; 4-62 points ） preoperatively to 84.8 points （ range; 80-90 points ） postoperatively. All 5 patients were satisfied with the hip function and joint stability. The surgical approach of hip arthroplasty, prosthesis selection, perioperative management, effects, complications and so on in long-term dialysis patients with end-stage renal disease were described in a total of 10 literatures. Conclusions The short-term follow-up results were satisfactory in long-term dialysis patients with hip arthroplasty. Based on the literature research, with the proper surgical approach, prosthesis selection, perioperative management and postoperative kidney expert assistance, better short-term results can be obtained in long-term dialysis patients with hip arthroplasty.