人工髋关节置换术后翻修原因分析

目的:分析人工髋关节置换术后翻修的原因,并评价其疗效。方法:本组30例(31髋)行人工髋关节置换术后翻修术,男12例,女18例,平均年龄63.1岁(47~74岁)。初次关节置换类型:全髋置换19例(20髋),人工股骨头置换11例。翻修原因:3例(3髋)为感染性松动,余均为无菌性松动。翻修距初次手术时间:1年以内1髋,2~3年3髋,8~10年21髋,10~15年6髋。翻修假体类型:均为混合型假体,国产12例(12髋),进口18例(19髋)。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。临床功能评价采用Harris评分。结果:30例均获随访,平均随访时间4.1年,术后所有患者双下肢基本等长(差距小于1 cm)。偏心距、前倾角、颈干角恢复至初次手术前水平,术后3个月均完全负重,髋关节疼痛除2例外其余完全缓解,至最后1次随访时,按Harris评分,优16髋,良10髋,可4髋,差1髋。无感染及髋关节脱位发生。结论:翻修的常见原因为无菌性松动、髋臼磨损和感染性松动;髋关节翻修是一种近期疗效满意的方法。

Reason analysis of failed hip replacement revision

Objective:To analyze the reason of revision for failed hip replacement and evaluate its clinical outcome.Methods:Thirty patients(31 hips) with the mean age of 63.1 years(47-74 years) of failed hip replacement were revised.The first operation was total hip replacement(19 cases) and femoral head replacement(11 cases).The revisional reasons included septic loosing(3 hips) and aseptic loosing(28 hips).The survival duration from the first operation to the revision was less than 1 year for 1 hip,2-3 years for(3 hips,)8-10 years for 21 hips and 10-15 years for 6 hips.All prothesis were mixed pattern which home-made 12 cases (12 hips) and foreign-made 18 cases(19 hips).Radiographic evaluation included lower leg discrepancy,femoral eccentricity,angle of anterior tilt before and after revision.Functional evaluation based on Harris score system.Results:All patients were followed up with average of 4.1 years.Lower leg discrepancy(less than 1 cm),femoral eccentricity,anterior tilt and collodiaphyseal angle were restore to normal limitation after operation on the basis of X-ray.All the patients were allowed full weight-bearing in 3 months after operation,hip joint pain in 2 cases and others cases complete remission.According to Harris score the excellent,good and fair function were 16,10 and 1 respectively.Hip joint infection and dislocation were not found.Conclusion:The main reasons of revision are aseptic loosing,acetabular erosion and septic loosing.Revision after THR can achieve satisfactory results.