复杂人工髋关节置换术35例

Early experience in complicated hip arthroplasty: a study of 35 cases

目的 探讨复杂人工髋关节置换术的经验。 方法 回顾分析复杂人工髋关节置换术 3 5例 ,其中人工髋关节术后感染 12例 ,髋臼畸形 10例 ,股骨短缩畸形 5例 ,髋关节骨性强直 8例。 结果 本组手术全部成功 ,术后无感染发生。随访 3个月～ 6年 ,平均 2年 8个月。 1例死亡 ,生存的 3 4例对手术结果满意。 结论 ( 1)感染的髋关节手术不宜单纯清创 ,应取出原关节行Ⅰ期或Ⅱ期翻修术 ,万古霉素骨水泥在翻修术中有利于感染的控制。 ( 2 )植骨以自体颗粒骨植骨较好 ,建议大块植骨时应辅以颗粒骨 ,并尽量选用钉板系统固定。 ( 3 )手术难度大 ,术前准备要求细心、全面 ,以随时处理可能出现的并发症 ,并制定多个预案 。

Objective To disscuss early experience in complicated hip arthroplasty. Methods Thirty-five cases of complicated hip arthroplasty were retrospectively analyzed. Of them, there were 12 cases of infected hip, 10 acctabular deformity, 5 femoral shortening and deformity and 8 fusion hip. The new arthroplasty was applied in all 35 cases. Results The operations succeeded in 35 cases without any infections. The mean follow up was 2 years and 8 months, ranging from 3 months to 6 years. During the follow up, 34 survived cases obtained good function, but one died. Conclusions (1) Because debridement with retention of the prosthesis rarely enables control of prosthetic joint infection, one-stage or two-stage revision surgeries should be considered. Vancocin-loaded polymethylmethacrylate is beneficial for treatment of prosthetic infection. (2) The good results come from the application of morselized bone only or supplemented with autografting bone. It is better to fix structure bone by means of the plate and screw system. (3) Much attention should be paid to preoperative preparation and complications that may occur during the operation. More than one plan should be made so as to timely find and correct the unexpected changes.