人工髋关节翻修术72例探讨

目的探讨人工髋关节置换术后失败的原因,骨缺损的处理、假体的选择及根据,观察翻修的术后疗效。方法2000年1月～2008年6月,本组共对72例患者进行了人工髋关节翻修术。翻修术所置换的假体包括,普通金属杯加内衬45例,大头臼杯15例,Cage加聚乙烯臼杯9例,聚乙烯臼杯3例;普通柄43例(其中12例应用骨水泥固定),加长柄29例(其中5例应用骨水泥固定,7例为组合型柄)。39例假体柄取出容易,20例假体柄取出困难。13例假体臼、17例假体柄使用骨水泥固定,其中10例臼及柄均使用骨水泥固定;55例假体臼、32例假体柄植骨,其中28例假体臼及柄均植骨。结果平均随访31.7个月。Harris评分:术前平均39.4(9～58)分,术后平均92.0(65～99)分。无感染或脱位患者。结论(1)无菌性松动、关节感染和医源性错误是人工髋关节翻修的主要原因;(2)股骨假体柄取出困难和严重骨质缺损是髋关节翻修术中常见的难题;(3)应用松质骨骨块、颗粒骨和骨屑混合打压植骨,尽量多用自体骨填补缺损,而少用异体骨、人工骨或骨水泥;(4)假体的选择主要依据是骨质缺损的程度。

Investigation on revision of total hip arthroplasty

Objective To discuss the reasons of failure and operative procedure of the revision of total hip replacement （ THR）, and to evaluate its curative effect. Methods From Jan 2000 to Jun 2008, seventy-two cases （72 hips） were revised. The prosthesis used in revision included general metal ring and lining（45 cases） , large head and cup（ 15 cases）, cage and polyethylene cup （ 9 cases） , general stem（43 cases, 12 cases fixed with bone cement）, lengthening stem（29 cases, 5 cases fixed with bone cement, 7 cases were combination type）. 20 stems were taken out with difficulties, and 39 were taken out easily. 13 mortars and 17 stem were fixed by bone cement, and bone cement were used inl0 cases both mortor and stem. 55 mortors and 32 stems adopted bone graft, 28 cases adopted bone graft both mortar and stem. Results The follow-up time averaged 31.7 months, the Harris score were increased from 39.4 （ rang 9 to 58） preoperatively to 92.0 （ rang 65 to 99 ） postoperatively. No case suffered infection or dislocation. Conclusions （ 1 ） The most common cause of revision is sterility loosening, infection, and iatrogenic fault; （2） Stems taking out difficulty and severe deossification were the frequent tough problems; （3） Bone impaction grafting mixed with spone bone block, particle and crumbs should be used to fill bone defect, it prefers autologous bone to variant, artificial bone and bone cenment for repairering the defect; （4） The choice of prosthesis mainly relies on the degree of bone defect.