骨水泥聚乙烯内衬固定技术应用于髋关节翻修的疗效研究

A retrospective study on the application of cemented polyethylene liner technique in hip revision

目的探讨骨水泥聚乙烯内衬固定技术(简称骨水泥内衬技术)应用于髋关节翻修术的疗效。方法回顾分析2011年1月—2013年12月行髋关节翻修术且符合选择标准的患者临床资料,翻修术中单纯更换内衬14例(A组),采用骨水泥内衬技术12例(B组)。两组患者性别、年龄、置换至翻修术时间以及术前髋关节Harris评分等一般资料比较,差异均无统计学意义(P>0.05)。比较两组术后髋关节功能(Harris评分)、并发症发生情况,以及X线片复查髋关节假体位置。结果两组患者均获随访,随访时间4.4～6.4年,平均5.4年。除两组各1例术中发生股骨劈裂骨折外,无其他并发症发生。术后患者髋部疼痛均缓解,跛行步态得到纠正。两组术后髋关节功能均逐步改善,术后3个月及末次随访时Harris评分均显著高于术前(P<0.05),末次随访时评分高于术后3个月(P<0.05)。但两组间术后3个月及末次随访时Harris评分比较,差异均无统计学意义(P>0.05)。X线片复查示,两组均未出现脱位、髋臼假体松动以及与界面相关的并发症。结论对于髋关节翻修术中不能行单纯更换内衬者,采用骨水泥内衬技术也可获得较好疗效,但应注意适应证的选择。

Objective To evaluate the effectiveness of cemented polyethylene liner technique in hip revision.Methods Based on inclusion criteria, the clinical data of 26 patients who were undergone hip revision between January2011 and December 2013, were retrospectively reviewed. Among them, 14 cases were treated with isolated liner exchange（group A） and 12 cases were treated with cemented polyethylene liner technique（group B）. There was no significant difference in gender, age, the time from primary total hip arthroplasty to revision, and the preoperative Harris score between 2 groups（P〉0.05）. The post-operative Harris score and complications were compared between 2 groups, and Xray findings of the hip joint were recorded to review the position of hip components. Results All patients were followed up 4.4-6.4 years（mean, 5.4 years）. Except for two femoral fractures during the revision（1 in each group）, there was no other complication in 2 groups. The hip pain relieved and the lame gait corrected in 2 groups. The hip＇s function of2 groups improved gradually after operation, with a better Harris score at 3 months and the best at last follow-up,compared with preoperative scores（P〈0.05）. There was no significant difference in Harris score at difference time points after operation between 2 group（P〉0.05）. X-ray films showed no dislocation, aseptic loosening, and other interface related complication. Conclusion For the cases without the chance to do change liner, cemented polyethylene liner technique has a good effectiveness. But restrict patient selection should be considered before hip revision.