全涂层表面微孔股骨假体在人工全髋关节翻修术中的应用

目的评价全涂层股骨假体在人工髋关节翻修术后的X线表现和临床效果。方法自1999年1月至2003年12月，对15例患者15髋采用全涂层表面微孔股骨柄假体进行全髋关节翻修术。男6例，女9例；年龄58～82岁，平均66岁。翻修原因：无菌性假体松动10例，感染性松动2例，假体松动、股骨骨折2例，股骨假体位置不良1例。所有患者均采用Harris髋关节评分和手术前、术后定期X线评价。结果15例患者均获随访，随访时问1～5年，平均2．3年。术前平均Harris评分为42分，最后随访时增加至89分。所有患者均在术后3个月后完全负重，原有髋关节疼痛缓解。在最后随访时，有14例股骨柄假体获得骨长入固定，有1例获得稳定的纤维固定。并发症包括股骨干骨折2例，其中1例为股骨柄尖端处无移位骨裂，1例为股骨假体柄远端穿出股骨皮质，术后脱位1例。本组中无假体固定失败的患者。无一例患者发生感染。结论全涂层非骨水泥股骨假体是髋关节翻修股骨侧的良好选择，近期X线和临床效果满意，对个子矮小的患者选用加长翻修柄应慎重。

Use of extensively porous-coated femoral stem in revision total hip arthroplasty

Objective To evaluate the clinical and radiographic results of extensively porous-coated femoral stem in revision total hip arthroplasty (THA). Methods From January 1999 to December 2003, revision THA with extensively porous-coated femoral stem was carried out in 15 cases including six males and nine females, with average age of 66 years (58-82 years). The reason for the revision included aseptic loosening in 10 cases, septic loosening in two, femoral fracture around loose implant in two and femoral revision for malposition of the femoral component in one. All cases were clinically evaluated using Harris hip score and radiographically evaluated both preoperatively and postoperatively at regular follow-up intervals. Results All cases were followed up for average 2.3 years (1-5 years). The average preoperative Harris hip score was 42 points, which improved to 89 points at the latest follow-up. At the latest follow-up, bone in-growth occurred in 14 hips and solid fibrous fixation in one. Complications were consisted of femoral shaft fracture in two cases (one undisplaced distal femur fracture and one cortical perforation at the tip of the prosthesis) and postoperative dislocation in one. There was no mechanical failure or infetion were seen. Conclusions Satisfactory results of short-term clinical and radiographic follow-up have been achieved by using extensively porous-coated femoral stem for revision THA. But orthopedic surgeons should be careful in selecting extensively porous-coated femoral stem wiht lenthened stalk for scrubby chinese cases.