人工全髋关节翻修手术的难度分析和处理对策

目的：探讨人工全髋关节翻修手术的难度和相应的处理对策。方法：对2002～2009年实施有完整的临床随访资料的人工全髋关节翻修手术21例进行分析。将翻修手术大体分为显露并取出原假体、植入骨床准备、新假体植入三大步骤,记录术中不同处理步骤的手术时间和手术总输血量。结果：随访1～5年,按照Harris评分标准,术前平均评（34.5±8.22）分,术后平均（83.6±9.43）分,优8例,良10例,中2例,差1例,优良率85.72%。除外术前麻醉时间和切口关闭时间,人工髋关节翻修手术的平均手术时间为112分钟,其中原假体取出的平均耗时为46分钟,占总时间的41%;植入骨床准备的平均耗时为39分钟,占总时间的35%;而新假体植入的平均耗时为27分钟,占总时间的24%。手术输血平均为495mL。结论：原假体取出耗时最多,特别对于骨水泥型假体其股骨侧髓腔内残留骨水泥的去除往往是手术最困难的环节之一。而骨缺损的修复和处理是手术中面临的难点,髋臼侧骨缺损的处理是重要的手术环节。当上述处理完善时,新假体的植入则相对便捷。

Difficulty analysis and management for revision of artificial total hip arthroplasty

Objective：To explore the difficulty and the corresponding counter measures of revision of artificial total hip arthroplasty through studying the whole courses and time of operation.Methods：To summarize and analyze the data of 21 patients with revision of artificial total hip arthroplasty in 2002~2009.The course of total operation was divided into three steps： revealing and removing the original prosthesis,implanting bone bed preparation？and new prosthesis.The intraoperative time of each step and the total transfusion volume were recorded.Results：According to Harris scoring,the mean score of 21 patients was 34.5±8.22 before operation and 83.6±9.43 after operation respectively.The perfect rate of joint function was 85.72%.Except the time of preoperative anesthesia and incision closing,the mean operation time was 112 min,in which the time of revealing and removing the original prosthesis was 46 min,accounting for 41% of the total time,the time implanting bone bed preparation was 39 min,accounting for 35%？of the total time,new prosthesis implantation was 27 min,accounting for 24% of the total time.The total blood transfusion volume was 495 mL.Conclusion：In the cource of operation,revealing and removing the original prosthesis is the most time consuming step,especially removal of residual bone cement of cemented prosthesis in femoral canal is often the most difficult link.The repair of bone defects is another difficulty,especially the management of acetabulum bone defects is the most key part.If to manage the above-mentioned two aspects well,the step of new prosthesis implantation is relatively easy.After all,sufficient pre-operation preparation,and regular and careful operation are the keys to the successful operation of revision of artificial total hip arthroplasty.