人工全髋关节翻修:85例随访

发布时间：2018-09-17 06:55

【摘要】：背景:随着接受人工髋关节置换手术的数量逐年增加,因假体本身的寿命以及各种并发症的发生,需行人工全髋关节翻修手术的数量也呈上升趋势。目的:探讨、分析人工全髋关节翻修术的原因、翻修假体临床应用、近期效果及相关翻修技术。方法:回顾性分析85例全髋关节翻修术患者临床资料,23例患者翻修时采用生物型T.O.P髋臼杯(异体骨块植入)加聚乙烯内衬,51例钛网杯加用骨水泥固定,11例超大型臼杯;普通柄63例(其中47例采用骨水泥固定),加长柄34例(组配型假体16例,18例骨水泥固定),采用Harris评分评估翻修髋关节功能。结果与结论:85例全部获得随访,平均随访30.2个月。(1)Harris评分:由术前平均30.07分,翻修术后增至平均90.32分;伤口愈合良好,无脱位、感染患者,并且髋关节功能活动获得了极大改善;(2)分析结果,假体的无菌性松动是翻修最主要原因,其次为假体的脱位;髋臼壁骨缺损以及股骨骨量减少是翻修过程中主要难题;术前对翻修术中可能出现的情况和意外做好充分准备,根据骨缺损情况合理选择假体,早期行人工全髋关节翻修获得良好的临床疗效。
[Abstract]:Background: with the increasing number of artificial hip arthroplasty procedures the number of total hip arthroplasty needs to be increased due to the life span of the prosthesis and the occurrence of various complications. Objective: to explore the causes of total hip arthroplasty, clinical application of revision prosthesis, short-term effect and related revision techniques. Methods: the clinical data of 85 patients with total hip revision were retrospectively analyzed. 23 patients were treated with biological T.O.P acetabular cup (allograft bone graft) and polyethylene lining 51 cases with titanium mesh cup and 11 cases with super large acetabular cup fixed with bone cement. There were 63 cases with common handle (47 cases with bone cement fixation) and 34 cases with extended handle (16 cases with matched prosthesis and 18 cases with bone cement fixation). The function of modified hip joint was evaluated by Harris score. Results and conclusion all 85 cases were followed up for an average of 30.2 months. (1) Harris score: the average score was 30.07 before operation and 90.32 after revision. The results showed that the aseptic loosening of the prosthesis was the main reason of revision, followed by the dislocation of the prosthesis, the defect of acetabular wall and the reduction of femoral bone mass were the main problems in the revision. Before operation, we should make full preparation for the possible situation and accident in revision operation, select the prosthesis reasonably according to the condition of bone defect, and get good clinical effect by early revision of total hip.
【作者单位】：河北医科大学第三医院骨病科;河北医科大学第四医院放射科;
【分类号】：R687.4

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