人工股骨头置换后的髋臼磨损:原因和处理

Acetabular wear after femoral head replacement:cause and management

背景:股骨头置换术后不同类型髋臼磨损的发生率在不同的研究之间存在差异,随着临床人工股骨头置换病例的增多,其并发症也逐渐凸显。目的:探讨人工股骨头置换术后髋臼磨损的原因及处理策略。方法:2012年6月至2019年10月河南省中医院关节科收治的人工股骨头置换术后因髋臼磨损导致失败的病例56例(56髋),给予全髋关节一期翻修治疗。患者因髋关节疼痛伴活动受限入院,术前Harris评分为33.71±1.85,目测类比评分为6.91±0.67,术后3,12,24个月定期随访,以后每年复查1次,并选取术前和术后随访的评定结果进行分析。结果与结论:①56例患者随访24-72个月,平均(47.52±15.80)个月,所有患者随访X射线摄片可见假体无松动、位置良好、力线正常,无感染等并发症;②术后随访各时间点Harris评分均显著高于术前(P<0.05),目测类比评分均显著显著低于术前(P<0.05);术后24个月Harris评分和目测类比评分与术后12个月随访比较,差异无显著性意义;③结论:人工股骨头置换后非感染的并发症主要是髋臼软骨磨损,疼痛为其主要症状,临床中如果软骨破坏或退变明显或预期寿命较长者,应慎用人工股骨头置换,如果术后出现髋臼软骨磨损并疼痛的情况,解决方式为给予患者一期人工全髋关节翻修处理,能够重建髋关节并恢复髋关节正常的功能。

BACKGROUND:The incidence of different types of acetabular wear after femoral head replacement varies between different studies.With the increase of clinical artificial femoral head replacement cases,its complications also appear gradually.OBJECTIVE:To investigate the causes and management strategies of acetabular wear after femoral head replacement.METHODS:From June 2012 to October 2019,56 failed cases of acetabular wear after femoral head replacement(56 hips)were admitted to the Department of Joint Medicine of Henan Province Hospital of TCM and received the total hip joint revision surgery.All patients were suffered hip pain with limited movement.Harris score was 33.71±1.85 and VAS score was 6.91±0.67 preoperatively.All cases were followed up regularly 3,12,and 24 months postoperatively,once every year thereafter.The results of preoperative and postoperative follow-up were analyzed.RESULTS AND CONCLUSION:(1)56 patients were followed up for 24-72 months,mean(47.52±15.80)months.X-ray films showed that all prostheses were no loosening and had good position as well as normal alignment.There was no infection or other complications.(2)The Harris score at each time point of postoperative follow-up was significantly higher than that before surgery(P<0.05),and the visual analogy scale score was significantly lower than that before surgery(P<0.05).There was no significant difference in Harris score or visual analogy scale score at 24 and 12 months after operation.(3)It is concluded that the non-infective complication after femoral head replacement is mainly acetabular cartilage wear;pain is a major symptom.In the clinic,if the cartilage damage or degeneration is obvious or the life expectancy is long,artificial femoral head replacement should be used with caution.If the acetabular cartilage is worn and painful after surgery,the solution is to give the patient a first-stage total hip revision.It would rebuild the hip joint and restore the normal function of the hip joint.