人工全髋关节置换术治疗化脓性髋关节炎后遗骨关节病的研究进展

目的总结人工全髋关节置换术(total hip arthroplasty,THA)治疗化脓性髋关节炎后遗骨关节病的研究进展。方法广泛查阅国内外近年相关文献,就THA治疗化脓性髋关节炎后遗骨关节病的时机、髋臼侧及股骨侧处理方法以及假体类型选择等方面进行总结分析。结果THA是治疗化脓性髋关节感染后遗骨关节病的有效手段,为避免感染复发,建议感染静止期达10年以上时手术。此类患者可能存在髋臼侧发育不良,髋臼覆盖率差,行THA时可选择高位造臼、髋臼内陷截骨、结构性植骨、Cage、钽金属垫块或3D打印假体等方式处理;股骨侧可能存在股骨髓腔细小、股骨颈前倾角增大、颈干角增大、大转子延长和骨质差等问题,行THA时可通过股骨截骨及选择合适型号假体进行处理。化脓性髋关节炎后遗骨关节病患者多较年轻,为获得更好的远期假体生存率,首选非骨水泥型假体。结论THA可有效治疗化脓性髋关节炎后遗骨关节病,但手术难度大、手术并发症相对较多,术者应有充分认识。

Research progress of total hip arthroplasty for patients with sequelae of suppurative hip arthritis

Objective To summarize the research progress of total hip arthroplasty(THA) in treatment of sequelae of suppurative hip arthritis. Methods The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized. Results THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or threedimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship. Conclusion THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.