组合式翻修股骨假体在人工全髋关节翻修术中的初步应用

Short-Term Results of Modular Extensively Porous-coated Revision Stem in Revision Total Hip Arthroplasty

目的 评价组合式全涂层翻修股骨假体在人工髋关节翻修术中的近期 X 线和临床效果。方法 自 2001年 5月至 2002年 11月,对 10例 12髋采用组合式全涂层翻修股骨柄进行全髋关节翻修术。男 3例,女 7例,平均年龄 54.2岁 (35～71岁)。其中,翻修原因除 1例感染性松动外,其余均为无菌性松动。X 线评价包括翻修前骨缺损翻修前后的下肢长度、股骨偏心距、前倾角及翻修后假体骨长入。临床功能评价采用 H arris 评分。结果 10例患者均获随访,随访时间 6～24个月,平均 13.5个月。术前 6例患者双下肢不等长超过 2cm ,术后所有患者双下肢均恢复或保持等长。股骨偏心距、前倾角、颈干角基本恢复至初次手术前的水平。所有患者均在术后 3～5个月后完全负重,术前髋关节疼痛缓解。至最后一次随访时,有 11髋股骨柄发生骨长入,1例牢固纤维长入。髋关节 H arris 评分由术前的平均 (25.67±15.58)分升高至术后平均 (72.44±9.36)分。并发症主要为术中发生股骨骨折 3例,无一例患者发生感染或髋关节脱位。结论 组合式全涂层非骨水泥股骨翻修假体能够极大地方便髋关节翻修术,近期 X 线和临床效果满意。

Objective To evaluate the short-term clinical and radiographic results of modular fully porous-coated stem in revision operation of total hip arthroplasty. Methods From May 2001 to November 2002, ten cases with twelve hips received revision total hip arthroplasty using modular Profemur R with fully porous-coated stem. There were three males and seven females and the average age was 54.2 years(35 ～ 71 years). The reasons for revision operation included aseptic loosing in eleven hips and septic loosing in one hip. All the patients were evaluated radiographically and clinically. Radiographic evaluation included the classification of bone loss, leg discrepancy, offset and antiversion before and after revision and bone in-growth postoperatively. Clinical evaluation were based on Harris score system. Results The average follow-up period is 13.5 months(range: 6 ～ 24 months). Leg discrepancy from more than 2 cm in six cases were restored to less than 1 cm postoperatively. Femoral offset, antiversion angle and neck-shaft angle were also restored to normal limitation. All the patients were allowed to full weight-bearing 3 ～ 5 months later and pain relief occurred in all involved hips. At the last follow-up, bone in-growth occurred in eleven hips and solid fibrous fixation only in one case. Harris score was improved from a mean of 25 to 72. Complications mainly consisted of femoral shaft fracture in three cases but no infection or dislocation was found postoperatively. Conclusions Satisfactory results of short-term radiographic and clinical follow-up can be achieved using modular fully porous-coated stem for revision total hip arthroplasty.