髋关节置换术后翻修危险因素的分析

发布时间：2019-04-12 06:53

【摘要】：目的：分析髋关节置换术后失败行翻修手术的病例，探讨髋关节置换术后翻修的危险因素和特点。资料与方法：回顾性分析2009年9月到2014年12月吉林大学中日联谊医院骨科行翻修手术的髋关节置换术后失败病例237例。外院手术失败163例（68.8%），本院手术失败74例（31.2%）。男128例（54.0%），女109例（46.0%）。初次置换时平均年龄53.4（19～86）岁，翻修手术时平均年龄59.1（21～87）岁。初次置换原发疾病，股骨头坏死127例（53.6%），骨折（股骨颈骨折、股骨粗隆间骨折、股骨头骨折、股骨近端粉碎性骨折、髋关节骨折）78例（32.9%），发育性髋关节发育不良16例（6.8%），类风湿性关节炎7例（3.0%），强直性脊柱炎6例（2.5%），髋关节结核2例（0.8%），骨肿瘤1例(0.4%)。初次置换时假体类型中，非骨水泥型130例（54.9%），骨水泥型77例（32.5%），反向混合型（骨水泥型臼杯，非骨水泥型股骨柄）17例（7.2%），混合型（非骨水泥型臼杯，骨水泥型股骨柄）13例（5.5%）。结果：初次髋关节置换术后失败行翻修的原因中，，假体无菌性松动118例（50.2%），感染73例（30.8%），脱位19例（7.6%），内衬磨损10例（3.8%），假体周围骨折8例（3.4%），其他（髂腰肌碰撞、股骨柄折断、股骨头假体头向摩擦、假体位置不佳、假体周围骨化、肢体假性延长）9例（3.8%）。假体生存时限（初次置换至翻修的时限）平均为5.7（0.0～29.0）年，反向混合型9.3年、骨水泥型7.4年、混合型5.1年、非骨水泥型4.3年，其中各种失败原因的假体平均生存年限为内衬磨损16.5年、无菌性松动7.3年、其他7.0年、假体周围骨折4.9年、感染2.9年、脱位0.2年。初次置换术后早期失败（＜5年）136例（57.4%），中期（5～10年）54例（22.8%），晚期（＞10年）47例（19.8%）。结论：髋关节置换术后失败行翻修术病例假体生存时限平均为5.7年，翻修原因主要有假体无菌性松动（50.2%），感染（30.8%），脱位（8.0%），内衬磨损（3.8%），假体周围骨折（3.4%），其他（3.8%）。
[Abstract]:Objective: to investigate the risk factors and characteristics of revision surgery after hip arthroplasty. Materials and methods: from September 2009 to December 2014, 237 cases of failed hip arthroplasty in the Department of Orthopaedics, China-Japan Friendship Hospital of Jilin University were retrospectively analyzed. 163 cases (68.8%) failed to operate in the outside hospital, 74 cases (31.2%) failed in our hospital. There were 128 males (54.0%) and 109 females (46.0%). The mean age at the first replacement was 53.4 (19 / 86) years, and the mean age at the revision operation was 59.1 (21 / 87) years. Primary replacement included 127 cases (53.6%) of femoral head necrosis, 78 cases (32.9%) of fracture (femoral neck fracture, intertrochanteric fracture, femoral head fracture, proximal femoral comminuted fracture, hip fracture). There were 16 cases of developmental dysplasia of hip joint (6.8%), 7 cases of rheumatoid arthritis (3.0%), 6 cases of ankylosing spondylitis (2.5%), 2 cases of tuberculosis of hip joint (0.8%) and 1 case of bone tumor (0.4%). In the first replacement, 130 cases (54.9%) were non-cement type, 77 cases (32.5%) were cement type, and 17 cases (7.2%) were reverse mixed type (cement-type cup, non-cement-type femoral stalk), and the type of prosthesis was non-cement type (54.9%), cement type was 77 cases (32.5%). There were 13 cases (5.5%) of mixed type (non-cement-type cup, bone-cement type femoral stalk). Results: there were 118 cases (50.2%) of aseptic loosening, 73 cases (30.8%) of infection, 19 cases (7.6%) of dislocation and 10 cases (3.8%) of lining wear. There were 8 cases (3.4%) with periprosthetic fractures, 9 cases (3.8%) with other fractures (iliopsoas muscle collision, femoral stalk fracture, femoral head friction, poor prosthesis position, periprosthetic ossification and limb pseudoextension). The average survival time of the prosthesis (from initial replacement to revision) was 5.7 (0.0) 29.0 years, 9.3 years in reverse mixing, 7.4 years in cement type, 5.1 years in mixed form and 4.3 years in non-cement type. The average life span of the prostheses due to various causes of failure was 16.5 years of lining wear, 7.3 years of aseptic loosening, other 7.0 years, 4.9 years of periprosthetic fractures, 2.9 years of infection, and 0.2 years of dislocation. There were 136 cases (57.4%) with early failure after primary replacement (< 5 years), 54 cases (22.8%) at the middle stage (5-10 years) and 47 cases (19.8%) at the late stage (> 10 years). Conclusion: the mean survival time of prosthesis after hip replacement failure was 5.7 years. The main causes of revision were aseptic loosening of prosthesis (50.2%), infection (30.8%) and dislocation (8.0%). Lining wear (3.8%), periprosthetic fractures (3.4%) and others (3.8%).
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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