终末期肾病患者行髋关节置换的特征

背景：终末期肾病患者由于长期的骨代谢、内分泌异常及使用激素，常易发生股骨颈骨折、股骨头缺血坏死等疾病。当需行人工关节置换时相对于常规髋关节置换具有不同的特点。目的：观察生物型或骨水泥型假体行全髋关节置换治疗终末期肾病合并髋关节疾病的情况。方法：回顾分析中山大学附属第三医院2006年6月至2012年3月问收治15例终末期肾病合并髋关节疾病患者行全髋关节或人工股骨头置换的临床资料，其中男4例，女11例；股骨颈骨折8例（1例为双侧股骨颈骨折），股骨头缺血坏死5例，骨关节炎2例，共16髋。关节置换的方式包括全髋关节置换9髋（生物型5髋，股骨侧为骨水泥型4髋），人工股骨头置换7髋（生物型2髋，骨水泥型5髋）。出院后门诊随访X射线观察假体周围有无透亮区出现和动态变化情况，采用Harris评分和SF-36评分评估关节功能恢复和生存质量改善情况。结果与结论：置换后随访时间为0．5—4年，呈偏态分布，中位数时间为30个月，Harris髋关节功能评分由置换前的（53．0±5．8）分增加至末次随访的（86．0±3．8）分。SF-36评分由置换前的（65．0±2．4）分增加至末次随访的（83．0±4．9）分。出院前出现5例并发症，2例置换后透析时出现低血压休克，2例肺部感染，1例伤口延迟愈合，经对症治疗后恢复。置换后随访未见假体松动、脱位、假体感染等并发症。早中期随访结果显示，对于合并终末期。肾病的髋关节疾病患者髋关节置换可以解除疼痛，改善髋关节功能，有效改善终末期肾病患者的生存质量，但部分患者由于本身终末肾病的进展可能会影响置换后的恢复效果。

Characteristics of total hip arthroplasty in patients with end stage renal disease

BACKGROUND： Due to the long-term bone metabolism, endocrine disorders and the application of hormones the end stage renal disease is prone to femoral neck fractures, femoral head avascular necrosis and other diseases. The patients with end stage renal disease have the characteristics that different to general hip joint replacement when having total hip arthroplasty. OBJECTIVE： To observe the characteristics of biological or cementless total hip arthroplasty for the treatment of end stage renal disease combined with hip diseases. METHODS： The clinical data of 15 end stage renal disease patients with hip disease （four males and 11 females） who received total hip arthroplasty or artificial femoral head replacement in the Third Affiliated Hospital of Sun Yat-sen University from June 2006 to March 2012 were retrospectively reviewed. There were eight cases of femoral neck fracture （one case of bilateral femoral neck fracture）, five cases of femoral head avascular necrosis, two cases of osteoarthritis, totally 16 hips. The joint replacement included total hip arthroplasty in nine hips （cementless type five hips, cemented type four hips） and hemiarthroplasty in seven hips （cementless type two hips, cemented type five hips）. The follow-up X-ray film was taken to observe whether the translucent zone could be seen around the prosthesis, as well as the dynamic changes, and the Harris hip score and SF-36 score were used to evaluate the recovery of joint function and improvement of life quality. RESULTS AND CONCLUSION： Patients were followed-up for 0.5-4 years after replacement, the followed-up time showed skewed distribution, and the median time was 30 months. Harris hip score was increased from preoperative （53.0±5.8） to the last follow-up （86.0±3.8）. SF-36 score was increased from preoperative （65.0±2.4） to the last follow-up （83.0±4.9）. There were five cases of complications before discharge, two cases of hypotension shock when undergoing dialysis after replacement, two cases of pulmonary infection, one case of delayed wound union, and all the patients recovered after treatment. No prosthesis loosening, dislocation or prosthesis infection was observed during follow-up after replacement. The early to medium-term follow-up results show that total hip arthroplasty can relieve pain and improve hip function and life quality during the treatment of end stage renal disease patients with hip diseases. Some patients do not have good postoperative follow-up results due to the progress of kidney disease.