大转子延长截骨钢丝固定结合自体骨屑植骨在全髋关节翻修术中的应用

Application of extended trochanter osteotomy wire fixation combined with autologous bone graft in revision of total hip arthroplasty

目的:探讨采用大转子延长截骨钢丝固定加自体骨屑植骨进行全髋关节置换翻修的临床效果。方法:自2010年12月至2018年12月,应用大转子延长截骨钢丝固定结合自体骨屑植骨,行全髋关节置换翻修术患者18例,其中男8例,女10例;年龄68~82(78.89±3.32)岁;初次置换术后至翻修时间9~22(16.33±2.93)年。术后定期随访记录患者截骨块愈合时间、完全负重活动时间、髋关节Harris评分及并发症等情况。结果:纳入研究的18例患者均获得随访,时间16~38(25.78±6.65)个月。手术切口均Ⅰ期愈合。切口长度16~21(18.89±1.32)cm。手术时间105~128(115.44±6.59)min;出血量240~285(267.44±13.77)ml。截骨块愈合时间12~18(15.61±1.75)周;患者完全负重活动时间14~22(17.78±2.53)周。术前髋关节Harris评分(47.11±5.04)分,完全负重活动时髋关节Harris评分(76.39±3.85)分,末次随访时髋关节Harris评分(82.22±2.76)分,差异有统计学意义(P<0.05)。随访期间,患者均未发生患肢短缩、感染、切口愈合不良、假体松动及下沉、假体周围骨折等并发症。结论:在全髋关节置换翻修术时,应用大转子延长截骨钢丝固定结合自体骨屑植骨,能够获得满意的临床治疗效果,但需要术者对翻修术前、术中及术后恢复等各个时期做好系统规划。

Objective:To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty.Methods:From December 2010 to December 2018,18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft,including 8 males and 10 females with an average age of(78.89±3.32)years old ranging from 68 to 82 years.The time from the initial replacement to the revision was 9 to 22(16.33±2.93)years.The patients were followed up regularly after operation.The healing time of osteotomy,the time of full weight-bearing activity,Harris score of hip joint and complications were recorded.Results:All 18 patients were followed up for 16 to 38 months with an average of(25.78±6.65)months.The incision length was 16 to 21 cm with an average of(18.89±1.32)cm;the operation time was 105 to 128 min with an average of(115.44±6.59)min,the bleeding volume was 240 to 285 ml with an average of(267.44±13.77)ml.The healing time of osteotomy was 12 to 18 weeks with an average of(15.61±1.75)weeks.Harris score of hip joint was(47.11±5.04)before operation,(76.39±3.85)during full weight-bearing activities,and(82.22±2.76)at the final follow-up(P<0.05).During the follow-up period,there were no complications such as limb shortening,infection,poor incision healing,prosthesis loosening and sinking,and periprosthetic fracture.Conclusion:In revision total hip arthroplasty,the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results,but the surgeon needs to make a systematic plan for the pre-revision,intraoperative and postoperative recovery.