人工髋关节置换首次手术失败处理分析

目的 总结人工髋关节置换首次手术失败的18例病例，并分析治疗方法。方法 310例施行髋关节置换术患者中，18例首次髋关节置换手术失败。其中全髋置换7例，人工股骨头(半髋)置换11例。发生髋臼松脱者4例，假臼断裂2例，假体松动下沉2例，假体穿出股骨外2例，早期髋关节脱位4例，髋关节感染3例，术后1d内死亡1例。17例中除1例行假体柄修整，1例假体取出和病灶清除外，其余均行全髋或半髋翻修术。结果 17例再手术后伤口均一期愈合，随访6月～4年，除1例不能行走、1例需扶拐行走外，其余患者均无特殊不适，生活基本能自理。结论 严格掌握手术指征，强化手术规范操作及术后管理，是减少手术失败和并发症的关键。

Analysis of the Failure after Hip Joint Prosthetic Replacement

Objective To analyze the causes and measurements of failure in total hip replacements. Methods Totally 18 failed cases in 310 hip joints replacements were analyzed, which included 8 males and 10 females aged from 58 84 years (mean age 65). TAR and HHR had been done in 7 and 11 patients respectively. Four cup loosening, two cup breaking and two sinking of the prosthetic had happened after the replacement. Besides, early dislocation and stem penetration of the femur had been found in 4 and 2 patients respectively. Postoperative joint infection had occurred in 3 cases. There was one death on the first postoperative day. The chief management for the remain 17 cases was revision of the THR and HHR except one who underwent removal of the prosthetic. Results All the patients got first intention healing of the operative wounds. Followed up for 6 months to 4 years, 15 patients showed satisfactory results, one was disabled in walking and one required the help of crutch. Conclusion Strict technic with careful post operative management provides the key for reduction of operative complications and failure.