人工全髋关节置换术后翻修的假体选择

SELECTION OF THE TYPE IN REVISION TOTAL HIP REPLACEMENT FOR FAILED HIP ARTHROPLASTY

目的 探讨人工全髋关节置换术后翻修的假体选择。 方法 1995年 1月～ 2 0 0 2年 6月进行全髋关节翻修术 33例 (33髋 ) ,其中男 7髋 ,女 2 6髋。翻修原因 :无菌性松动 2 2例 ,感染后松动 8例 (其中 2例合并窦道形成 ) ;股骨头置换术后髋臼磨损 3例 ,不伴有假体中心性脱位。对无菌性松动和股骨头磨损患者采用骨水泥固定型假体 13例 ,生物固定型假体 12例 ,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体 ,8例感染患者均行一期骨水泥固定型全髋置换。 结果 随访 6个月～ 7年 6个月 ,平均 3年 11个月。 2例出现 X线透亮带 ,但无临床不稳 ;4例遗留持续性疼痛 ,无假体脱位、断裂。本组 Harris评分由术前的 2 4～ 4 7分 (平均 38.6分 ) ,上升为术后的 6 8～ 88分 (平均 82 .4分 ) ,满意率87.9%。 结论 无菌性松动是全髋关节置换术后翻修的主要原因。髋臼侧翻修假体可选择骨水泥型假体、也可选择生物型假体 ,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体 ,感染后的翻修选择骨水泥假体较好。

Objective To evaluate the selection of the type of prosthesis in revision hip arthroplasty. Methods There were 33 hips in our study,male in 7 hips and female in 26 hips.The average age of the patients were 59 years.The reasons of the revision included aseptic loosing in 22 hips, infection in 8 hips(2 infection hips with discharging sinuses),and acetabular erosion in 3 hips.The operations for revision were 13 cemented and 12 cementless acetabular prosthesis with autograft in morselized form;the femoral revision were all selected in cemented prosthesis.The revision for infection hip were all cemented prosthesis of extensively porouse-coated. Results The average follow-up duartion was 3.9 years and 11 months.There was a radiolucency but no clinical instability accompanied in 2 hips and remaining moderate pain in 4 hips.No dislocation and fracture were seen in the series.Harris score were improved to 82.4(68-88). Conclusion The commonest reason of revision hip arthroplasty was aseptic loosing.The acetabular prosthesis in revision could select cemented or cementless components and femoral prosthesis could select extensively coated stem.The cemented components could yield good results in infection hips revision.