生物型假体在老年全髋关节翻修术中的应用

Application of biological prosthesis in hip revision operation for the elderly patients

目的 探讨生物型假体应用于老年髋关节翻修手术的疗效.方法 采用生物型及骨水泥型两种假体进行老年髋关节单侧翻修术78例.随机将78例患者分为生物型假体翻修组40例（A组）和骨水泥假体翻修组38例（B组）.从手术时间、出血量等一般情况及术后感染、脱位、骨溶解及Harris评分等评价两组手术的安全性及疗效.结果 两组患者均获得2～11（5.8±2.3）年随访.A组患者手术时间为80～200（138.7±48.9）min,手术出血量为400～2000（980.0±560）ml,术中采取截骨处理15例,20例患者进行植骨,术后未见感染病例、骨溶解及假体松动病例,1例患者在术后发生假体脱位,1例出现假体松动进行再次翻修,假体存活率95％,末次随访时Harris评分平均为（88.7±9.8）分;B组患者手术时间为78～220（140.7±51.9）min,手术出血量为300～2000（960.0±600）ml,术中采取截骨处理13例,21例患者进行植骨,术后骨水泥反应1例,术后假体脱位2例,假体松动病例4例,所有患者均进行再次翻修处理,假体存活率为81.6％,末次随访时Harris评分平均为（81.9±10.7）分.结论 对于老年患者行髋关节翻修术生物型假体具有早期稳定性高,中远期疗效满意的优点,值得在临床上推广.

Objective To assess the operative technique and results with the usage of cementless prothesis in hip revision for the elderly patients.Methods Retrospective study was done on revision of total hip arthroplasty with cementless prothesis in 78 patients.The patients were randomly divided into two groups.The application of biological prosthesis was performed in 40 patients with revision patients （A group） and 38 revision performed in patients with bone cement prosthesis （B group）.The operation time,bleeding quantity in general and postoperative infection,dislocation,osteolysis and Harris score of the two groups of clinical efficacy and safety of operation were observed.Results 78 patients received 2-11 （5.8±2.3） years of follow-up.The operation time of A group was 80-200 （138.7-±-48.9） min.The operation hemorrhage of A group was 400-2000 （980±560） ml.The survival rate of A group was 95%.The mean Harris score of A group was 88.7±9.8.The operation time of B group was 78-220 （140.7±51.9） min.The operation hemorrhage of B group was 300-2000 （960± 600） ml.The survival rate of prosthesis of B group was 81.6 %.The Harris score of B group was 81.9 ± 10.7.Conclusion For elderly patients with hip joint revision biological prosthesis has advantages of early high stability,long term satisfactory effect.