115例人工髋关节翻修手术临床分析

发布时间：2018-05-20 13:29

本文选题：人工髋关节 + 松动　；参考：《新乡医学院》2015年硕士论文

【摘要】：背景人工全髋关节置换术是治疗髋关节疾病有效的方法之一,它的出现使得髋关节疾病给患者带来的关节疼痛得到有效的缓解和消除,患者的髋关节功能和活动度得到大幅提高,进而使患者的生活质量得到有效的改善。近年来,一些术后并发症的出现,如假体无菌性松动、感染,假体周围骨折等,导致患者患肢出现不同程度的疼痛,关节活动度受限,甚至肢体短缩畸形。这个时候就需要行髋关节翻修术来解决这些并发症。目的通过回顾河南省人民医院近5年来进行的人工髋关节翻修手术,对115例患者进行临床随访分析,探讨人工髋关节翻修的原因和其短期的临床疗效。方法2009年03月～2014年10月我院共进行了135例140髋人工髋关节翻修术,其中115例115髋获得了完整的随访资料,男60例,女55例,年龄27～86岁,平均66岁,左72髋,右43髋,初次置换距翻修术0.25～20年,平均8年。初次手术类型包括人工股骨头置换11髋,全髋关节置换104髋。分析翻修患者初次髋关节置换术后行翻修术的原因,对患者术前及末次随访给予Harris及VAS评分及影像学检查,对患者髋关节功能进行评估,并对翻修近期效果做出评价。结果本组病例翻修原因：假体无菌性松动61例(53%),术后感染22例(19%),假体周围骨折20例(17%),脱位12例(11%)。患者术后患髋疼痛症状均较术前改善,术后随访时间平均40个月(10～60个月),末次随访时本组患者VAS评分(1.10±0.892)分较术前(7.52±1.071)分显著降低,Harris评分(85.30±6.728)分较术前(36.06±7.518)分显著提高,其中优40髋(90～100),良63髋(89～80),可8髋(79～70),差4髋(70),Harris优良率89.57%,(P0.05),差异有统计学意义。本组患者术后无1例感染及脱位,假体松动及下沉病例,末次随访时影像学结果显示：植入假体位置良好,假体周围未见透亮线及骨溶解。结论假体无菌性松动是导致髋关节翻修的主要原因,其次是感染、假体周围骨折和假体不稳定导致的脱位；髋关节翻修可以有效的解决髋关节置换术后相关的并发症,通过随访短期疗效满意,远期疗效如何需要进一步随访分析。
[Abstract]:Background Total hip replacement is one of the effective methods for the treatment of hip diseases. The hip function and range of motion of the patients were greatly improved, and the quality of life of the patients was improved effectively. In recent years, some postoperative complications, such as aseptic loosening of prosthesis, infection, periprosthetic fracture and so on, have led to pain in the affected limb, limited joint movement, and even limb shortening. At this point, hip revision is required to address these complications. Objective to investigate the causes and short-term clinical effects of artificial hip revision in 115 patients by reviewing the revision operation of artificial hip in Henan Provincial people's Hospital in recent 5 years. Methods from March 2009 to October 2014, a total of 135 cases (140 hips) underwent revision of the artificial hip joint in our hospital. 115 cases (60 males and 55 females) were followed up. The average age was 2786 years (mean 66 years), left 72 hips and right 43 hips. The first replacement distance was 0.25 ~ 20 years (mean 8 years). The primary types of operation included artificial femoral head replacement (11 hips) and total hip arthroplasty (104 hips). The causes of revision after primary hip arthroplasty were analyzed. Harris and VAS scores and imaging examination were given to the patients before and after the last follow-up. The function of the hip joint was evaluated and the short-term effect of the revision was evaluated. Results the causes of revision were aseptic loosening in 61 cases, postoperative infection in 22 cases, periprosthetic fracture in 20 cases and dislocation in 12 cases. The postoperative hip pain symptoms were improved after operation. The average follow-up time was 40 months to 60 months. At the last follow-up, the scores of VAS score (1.10 卤0.892) were significantly lower than those before operation (7.52 卤1.071), and the scores of VAS score (85.30 卤6.728) were significantly higher than those of preoperative patients (36.06 卤7.518). The excellent and good rate of Harris was 89.57% (P 0.05) in 40 hips of excellent quality (40 hips), the good rate of good 63 hips (89 ), the fair rate of 8 hips (79%) 70%, and the poor rate of 4 hips (4 hips) with P 0.05% (P 0.05). There was no infection, dislocation, loosening and sinking of the prosthesis after operation. The imaging results of the last follow-up showed that the implanted prosthesis was in a good position with no clear lines and osteolysis around the prosthesis. Conclusion prosthetic aseptic loosening is the main cause of hip revision, followed by infection, periprosthetic fracture and dislocation caused by prosthesis instability. After a short-term follow-up, the long-term results need to be further followed up analysis.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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