人工全髋关节置换术和翻修术后并发异位骨化的风险因素分析

目的:探讨人工全髋关节置换术(THA)和翻修术后异位骨化(HO)形成的影响因素、临床特点、创伤机制和预防方法.方法:我院2004年1月～2010年12月行THA及翻修术287例,其中男98例,女189例;年龄56~72岁,平均63岁.其中≤65岁140例,＞65岁147例;THA 257例,翻修术30例.所有患者术后均口服阿斯匹林50 mg/d×30 d.两位骨科医师根据患者术前和术后双髋关节正、侧位X线摄片,按Brooker分级标准评定HO产生情况.按Harris评分标准评定髋关节功能.结果:本组287例均随访1 a以上,共有45例发生HO(15.68%),其中Brooker I型29例(64.44%),BrookerⅡ型14例(31.11%),BrookerⅢ型2例(4.44%),未发现BrookerⅣ型.HO发生率在男性为23.47%、女性11.64%,≤65岁10.71%、＞65岁20.41%,初次THA后10.89%、翻修术后56.67%,不同性别、年龄、术式间比较,差异均有统计学意义(P＜0.05).结论:在THA及翻修术后应常规预防HO;对HO形成的高危因素如翻修手术,围手术期应尽早采取干预措施.

Clinical Study on Heterotopic Ossification after the Operation of Total Hip Arthroplasty and Revision

Objective：To discuss the influencing factors, clinical features, trauma mechanism and pre vention of forming heterotopic ossification （ heterotopic ossification, HO ） after the operation of total hip arthro plasty（ total hip arthroplasty, THA）and revision. Methods：From January 2004 to December 2010 , 287cases were operated on THA and revision surgery（ 98 males and 189 females） . All patients were aged from 56 to 72 years（ mean 63 years） , of which 257 cases were operated on THA and 30 cases were conducted revision. 140 cases were less than or equal to 65 old years. 147 cases were more than 65 old years. All patients were given o ral aspirin a daily dose of 50rag with a total of 1 mouth. According to hip X ray with patients before and after surgery, two orthopedic surgeons analyzed and evaluated the formation of HO. HO was assessed according to Brooker grading standards. Hip function was assessed according to Harris score criteria. Results ：287 cases were followed up in 1 year. 45 cases occurred HO. The incidence of HO was approximately 15.68%. The incidence of HO in 45 cases with Brooker I type was 64.44%, Brooker I1 type 31.11%, Brooker m type 4.44%, not found in Brooker IV type. The incidence of HO in men was 23.47%, women 11.64%. The incidence of HO in patients less than 65 years was 10. 71%, patients more than 65 years 20.41%. The incidence of HO in pa tients with THA was 10.89%, revision 56.67%. There was significant difference in HO between the male and female, less than or equal to 65 years of age and more than 65 years of age , THA and revision surgery （ P 〈 0.05 ）. Conclusions：Routine prevention from HO should be performed for the patients after THA and revision. Patients with high risk factors of formation of HO such as revision should be early interfered in treatment.