保留股骨侧假体的髋关节翻修的临床疗效评析

Clinical Outcome of Isolated Acetabular Revision with Femoral Components Retained

目的探讨在髋关节翻修中保留股骨侧假体、单纯行髋臼侧翻修的短中期疗效。方法对2005年2月至2013年1月间采用保留股骨侧假体、单纯行髋臼侧假体翻修的31例31髋进行回顾性分析,其中男17例,女14例;年龄48~77岁,平均（64.32±8.76）岁。髋臼侧内衬磨损、无菌性松动、移位26例,髋关节脱位3例,髋臼骨折2例。股骨侧采用骨水泥固定的12例,生物固定的19例。进行翻修手术距离初次手术3个月~13年,平均（56.65±40.19）个月。18例翻修用髋臼与股骨侧假体保持同一厂家,13例因产品原因更换厂家。术中常规先行股骨侧假体稳定性的测试,评估股骨侧假体位置,对于股骨近端存在骨溶解的病例,溶解骨清理后进行打压植骨,单纯行髋臼侧翻修,采用Harris评分和X线片对其临床效果进行评估。结果术后随访12~103个月,平均（53.94±22.89）个月,Harris评分由翻修前平均（40.29±7.88）分增加至术后平均（86.42±5.2）分。所有患者无感染及关节脱位,未见假体移位,没有再翻修病例。结论全髋翻修中,根据患者年龄情况、股骨侧假体的固定情况、骨溶解的情况、初次置换假体选择情况、初次置换与翻修手术间隔时间情况,对部分患者采用保留股骨侧假体、单纯行髋臼侧翻修,可减少手术创伤,短中期随访效果满意。

Objective To determine the short and midterm outcome of isolated acetabular revision with femoral components retained. Methods We retrospectively reviewed the clinical and radiographic outcome for 31 patients（ 31 hips） who underwent isolated revision acetabuloplasty without removal of femoral components from 2005 to 2012,which include 17 men and 14 women. The average age of the patients at the time of the follow up was（ 64. 32 ± 8. 76） years（ range from 48 to 77years）. The acetabular revision was caused by lining wear,aseptic loosening,and migration in 26 hips,recurrent dislocation in3 hips and acetabular fracture in 2 hips. Of the 31 femoral components,12 were cemented and 19 were cementless. The period from primary THA to revision was 3 months to 13 years,average（ 56. 65 ± 40. 19） months. Producers of acetabular components were in accordance with those of femoral components in 18 patients,while another 13 producers had to be changed because of product. During procedures,we evaluated the stability and position of femoral components to decided whether to retain them.Some proximal femur with acceptable osteolysis experienced osteolytic lesion debridement and bone grafting. We evaluated the clinical outcome by Harris score and radiographs. Results The average duration of follow-up from the time of the index revision was 53. 94 ± 22. 89 months（ range from 12 months to 103 months）. The mean Harris score increased from 40. 29 ± 7. 88 points preoperatively to 86. 42 ± 5. 2 points. No patients had infection and dislocation. No patients had component migration or loosening on radiographs. Conclusion During hip revision,femoral components retained and isolated acetabular revision in partial patients can reduce the trauma of operation,and have a satisfactory short and mid-term results.