人工髋关节置换术失败原因分析

Analysis of failed total hip arthroplasty

目的对人工髋关节置换术后失败的病例进行分析，总结经验，提高人工髋关节置换术的长期疗效。方法 1996年 11月～ 1999年 4月共进行人工髋关节翻修手术 35例 (36髋 )，根据前次手术失败的原因进行分组并分析。结果根据病例统计，在同一失败病例中，失败的原因往往不止一个。最常见的原因是假体松动、假体周围骨溶解，共 24例次，其次为人工股骨头引起髋臼磨损 7例次，假体置入位置不良 6例次，人工髋关节脱位 3例次，术后感染 3例次，假体股骨柄断裂 2例次。结论人工髋关节置换术作为髋关节重建的一种有效的治疗方法而得到广泛的应用，其长期可靠的疗效与严格掌握手术指征，假体的适当选择和手术中正确操作有关。

Objective To analyse the failed total hip arthroplasty(THA) and to improve its long term results. Methods Thirty five patients(36 hips) undergone revision THA from November 1996 to April 1999, were grouped according to the different causes of the primary failed THA. Results Statistical analysis failed to show the factors related to the failures. In any one failed case, the causes were usually more then one item. The most common causes of failed surgery found in 24 cases were aseptic loosening and peri prosthetic osteolysis, wear out of acetabulum was seen in 7, malpositioned prostheses in 6 and postoperative dislocation in 3. Infection and fracture of femoral stem happened in 3 and 2 patients respectively. Conclusion THA has been extensively used as an effective procedure for the reconstruction of hip joint. Long term excellent clinical results are related to strict selection of indications, appropriate prosthesis, and finally the experience and surgical technique of the surgeon are also of importance to the final outcome.