生物型加长柄用于髋关节翻修的早期疗效

发布时间：2018-12-12 06:20

【摘要】：[目的]探讨应用生物型翻修加长柄行人工髋关节翻修术的早期临床疗效。[方法]回顾性分析2013年1月~2015年7月于本科接受人工髋关节翻修术的73例(73髋)患者的病例资料,男46例,女27例;年龄46~78岁,平均(64.40±8.27)岁。髋关节翻修术距离初次人工全髋置换的时间是5~34年,平均8.6年。通过比较各组手术时间、术中出血量、住院时间、下地活动时间、随访时间、并发症和Harris髋关节评分评估临床疗效,术后定期复查X线片评估假体稳定性、骨长入等情况。[结果]全部病例随访时间8~36个月,平均(20.21±4.21)个月。手术时间假体无菌性松动组为(163.25±12.74)min,假体周围骨折组为(187.30±18.85)min,假体周围感染组为(127.35±10.27)min(F=43.89,P0.01);术中出血量假体无菌性松动组为(382.52±47.53)ml,假体周围骨折组为(427.67±61.72)ml,假体周围感染组为(317.83±28.49)ml(F=12.24,P0.01);平均住院时间假体无菌性松动组为(10.40±3.35)d,假体周围骨折组为(16.31±4.43)d,假体周围感染组为(10.84±2.36)d(F=19.46,P0.01);平均下地活动时间假体无菌性松动组为(24.12±9.75)d,假体周围骨折组为(38.41±12.43)d,假体周围感染组为(31.79±7.39)d(F=13.74,P0.01);Harris髋关节评分假体无菌性松动组从术前的(46.89±8.63)分提高至末次随访时的(85.76±6.48)分,差异有统计学意义(t=24.43,P0.01);假体周围骨折组从术前的(45.90±7.98)分提高至末次随访时的(83.90±6.27)分,差异有统计学意义(t=17.16,P0.01);假体周围感染组从术前(48.12±7.22)分提高至末次随访时的(88.67±5.79)分,差异有统计学意义(t=10.73,P0.01);各组间末次随访评分(F=1.44,P0.05)无明显差异。患者术后切口均Ⅰ期愈合,无下肢深静脉血栓及坐骨神经损伤等并发症出现。随访期间假体周围可以看到明显的骨长入,无假体松动和感染者,植骨处无明显骨吸收及假体下沉。[结论]使用生物型翻修加长柄行人工髋关节翻修术,早期疗效满意,能明显改善髋关节功能,但远期疗效有待进一步观察。
[Abstract]:Objective: to investigate the early clinical effect of artificial hip joint revision with biological revision and long handle. [methods] the data of 73 cases (73 hips) undergoing revision of artificial hip joint from January 2013 to July 2015 were analyzed retrospectively. There were 46 males and 27 females, with an average age of (64.40 卤8.27) years. The distance from the first total hip arthroplasty to total hip arthroplasty was 5 ~ 34 years (mean 8.6 years). The clinical efficacy was evaluated by comparing the operative time, intraoperative bleeding amount, hospitalization time, floor movement time, follow-up time, complications and Harris hip score. [results] all cases were followed up for 8 ~ 36 months (mean (20.21 卤4.21) months). The operative time of aseptic loosening group was (163.25 卤12.74) min, periprosthetic fracture group was (187.30 卤18.85) min, periprosthetic infection group was (127.35 卤10.27) min (Fau 43.89 P0.01); The volume of blood loss in the aseptic loosening group was (382.52 卤47.53) ml, periprosthetic fracture group was (427.67 卤61.72) ml, periprosthetic infection group was (317.83 卤28.49) ml (FU 12.24 P0.01); The mean hospitalization time was (10.40 卤3.35) days in the prosthetic aseptic loosening group, (16.31 卤4.43) days in the periprosthetic fracture group and (10.84 卤2.36) d () FF19.46 (P0.01) in the periprosthetic infection group. The mean time of ground movement was (24.12 卤9.75) days in the prosthetic aseptic loosening group, (38.41 卤12.43) days in the periprosthetic fracture group and (31.79 卤7.39) d (/ L) in the periprosthetic infection group (P < 0.01). The score of Harris hip joint score increased from (46.89 卤8.63) to (85.76 卤6.48) at the last follow-up in the aseptic loosening group (t = 24.43, P0.01). The score of periprosthetic fracture increased from (45.90 卤7.98) before operation to (83.90 卤6.27) at the last follow-up, and the difference was statistically significant (t = 17.16, P 0.01). The score of periprosthetic infection increased from (48.12 卤7.22) to (88.67 卤5.79) at the last follow-up (t = 10.73, P 0.01). There was no significant difference in the final follow-up score among the groups (P 0.05). No complications such as deep vein thrombosis and sciatic nerve injury occurred. During the follow-up period, there was no apparent osseous penetration, no loosening and infection of the prosthesis, no apparent bone resorption and prosthesis sinking in the site of bone graft. [conclusion] the early curative effect of artificial hip revision with biological revision and long handle is satisfactory, and the function of hip can be improved obviously, but the long-term effect needs further observation.
【作者单位】：赣南医学院第一附属医院骨科;赣南医学院;
【分类号】：R687.4

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