人工全髋关节置换后33例翻修原因解析

背景：人工髋关节置换后出现感染、假体松动、假体磨损断裂、骨溶解、复发性脱位等并发症的数量逐渐增多，最终导致行全髋关节翻修。 目的：分析人工全髋关节置换后进行翻修的原因和治疗措施。 方法：对33例患者全髋关节翻修的原因、假体选择、骨缺损处理及康复进行分析研究。其中髋臼有21例行普通金属杯加内衬置换、8例行大头臼杯置换、4例行聚乙烯臼杯置换。股骨柄有15例行普通柄(11例应用骨水泥固定)置换、18例行加长柄置换(9例应用骨水泥、6例为组合型柄)。 结果与结论：33例患者全部获得随访，翻修后随访24-60个月，平均随访36.5个月；翻修后伤口愈合良好，假体固定可靠，未再次出现感染脱位患者；髋关节功能均得到了较大的改善，Harris评分：翻修前平均为37.1分，翻修后平均为91.3分。中短期临床随访结果示，若翻修手术指征正确，骨缺损处理得当，翻修假体选择正确，行一期人工全髋关节翻修可以获得良好的临床疗效。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Reasons for revision in 33 patients after total hip replacement

BACKGROUND: The number of complications after hip replacement, such as infection, implant loosening, fracture prosthesis wear, osteolysis, and recurrent dislocation, had drastically increased. These complications would induce the increased occurrence of total hip revision. OBJECTIVE: To analyze the causes and treatment measures of revision after total hip replacement. METHODS:The reasons for revision, the prosthesis selection, the treatment of bone defect and the postoperative rehabilitation were discussed in 33 cases after total hip replacement. The prosthesis for revision included general metal ring and lining (21 cases), large head and cup (8 cases), polyethylene cup (4 cases), general femoral components (15 cases, including 11 cases fixed by bone cement), and lengthening femoral components (18 cases, including 9 cases fixed by bone cement and 6 cases of combined components). RESULTS AND CONCLUSION: All 33 patients were followed up for 24-60 months, averagely 36.5 months. After revision, wound healed perfect, and the prosthesis was reliable. No case suffered from infection or dislocation. Hip joint function was greatly improved. Harris score was increased from 37.1 preoperatively to 91.3 postoperatively. Medium- or short-period clinical follow-up results demonstrated that if the indication of revision was right, bone defects were handled perfectly, prosthesis was chosen correctly, one-stage total hip revision can get a good clinical efficacy.