摘要
[目的]探讨人工髋关节置换术后翻修的原因及处理方法。[方法]回顾性分析1993年4月～2015年5月在本科行人工髋关节翻修术患者405例,其中男性202例,女性203例,左侧224例,右侧181例,年龄28岁～93岁,平均(61.43±27.82)岁,总结翻修原因以及手术处理方法等。[结果]假体松动280例,其中柄松动87例,臼松动39例,柄和臼假体均松动154例;翻修前假体平均使用时间6个月～24年,平均(6.68±4.82)年。感染66例,其中16例一期旷置,待感染控制后二期再行假体置入;其余50例均行一期翻修假体置入。关节不稳所致脱位15例,均为闭合复位失败或保守治疗失败, 3例行单纯切开复位, 3例更换内衬和股骨头,1例更换股骨侧假体,3例更换髋臼侧假体,3例行全髋翻修。聚乙烯衬垫磨损但假体无松动14例,8例予以更换内衬和股骨头,4例更换髋臼侧假体和股骨头,2例行全髋翻修。股骨头置换术后髋臼磨损11例,5例仅置换髋臼侧,更换股骨头假体,6例行全髋翻修。股骨柄假体周围骨折11例,以捆绑带固定或钢板螺钉固定或更换加长柄假体结合内固定等治疗。假体机械断裂6例,予以更换假体。股骨柄假体偏心距过大导致疼痛1例,予以更换股骨柄假体。髋臼螺钉位置不当导致坐骨神经症状1例,予以调整髋臼假体和螺钉位置。[结论]假体松动是人工髋关节翻修最常见原因,其次为感染、脱位、聚乙烯磨损、股骨头置换术后髋臼磨损、假体周围骨折等;人工髋关节翻修的方案需根据假体失败的原因、患者具体情况以及医生的经验等因素综合考虑。
[Objective] To explore the causes and management of revision hip arthroplasty. [Methods] A retrospective study was conducted on 405 consecutive patients who underwent revision hip arthroplasty in our department from April 1993 to May 2015. Of them, 202 males and 203 females aged from 28 to 93 years with an average of （61.43±27.82） years old. The causes for revision and corresponding surgical techniques used were summarized. [Results] In term of revision cause, prosthetic loosening happened in 280 patients, including merely stem involved in 87, acetabular cup involved in 39 and both stem and acetabulum involved in 154, with a mean prosthetic survival time of （6.68±4.82） years ranged from 6 months to 24 years. In addition, the periprosthetic infection occurred in 66 patients, among whom, 16 patients with sinus or abscess were treated by two-stage revision, while the remaining 50 patients were treated by one-stage revision. Furthermore, the dislocation due to hip instability and failed to nonoperative treatment was found in 15 patients, of whom 3 patients were treated by open reduction followed by 6-week plaster fixation, 3 pa- tients received head and liner exchange only, 1 patients underwent stem exchange, 3 patients had acetabular prosthesis exchange, and 3 patients were treated by total hip revision. Moreover, the polyethylene liner wear without loosening was noted in 14 patients, among whom 8 patients had merely head and liner exchanged, 4 patients got acetabulum and head prosthesis exchange, and the remaining 2 patients treated by total hip revision. Additionally, the acetabular wear after hemiarthroplasty happened in 11, among whom 5 patients had head prosthesis exchanged, and the remaining 6 patients were revised by total hip arthroplasty. Besides, the periprosthetic femo- ral fracture occurred in 11 patients who had fractures fixed with cerclage band or plate-screw, or replacement of a lengthened prosthetic stem depending on the Vancouver type of the fracture. The mechanical fracture of prosthetic stem happened in 6 patients who had the stem exchanged. Persistent pain induced by oversize femoral prosthetic offset occurred in 1 patients who tin- derwent femoral component exchange. The sciatic nerve irritation by acetabular screw happened in 1 patient who had position of acetabular prosthesis and screw readjusted. [Conclusion] Prosthesis loosening is the most common cause for revision hip arthroplasty, followed by infection, dislocation, polyethylene liner wear, acetabular wear after hemiarthroplasty, periprosthetic fracture and so on. The revision hip arthroplasty depends on a comprehensive consideration of the prosthesis failure reason, the patient＇s specific situation, and the experience of the doctor.
作者
李儒军
陶可
寇伯龙
袁燕林
关振鹏
周殿阁
林剑浩
LI Ru-jun;TAO Ke;KOU Bo-long;YUAN Yan-lin;GUAN Zhen-peng;ZHOU Dian-ge;LIN Jian-hao(Department of Joint Surgery,Peking University People Hospital,Beijing,100044,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第19期1729-1734,共6页
Orthopedic Journal of China
基金
国家自然科学基金资助项目(编号:81641175
81672183)
国家重点研发计划项目(编号:2016YFC1101800
2017YFC0108003)
北京市科委重大项目(编号:D171100003217002
Z171100002717094)
北京大学人民医院院内发展基金资助项目(编号:RDB2015-10
RDY2016-15)
2015年国际骨关节炎研究协会(OARSI)访问学者奖学金
2016年国际软骨修复协会(ICRS)奖学金
2016年北京厚爱关节健康公益基金会青年学者奖学金
