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,P<0.01);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,P<0.01);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,P<0.01);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,P<0.01);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,P<0.01);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,P<0.01);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,P<0.01);各组间末次随访评分(F=1.44,P>0.05)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。
[Objective] To evaluate the short-term clinical outcomes of long-stem cementless prosthesis for hip revision. [Methods] From January 2013 to July 2015, 73 patients （73 hips） undergoing hip revision, who met the inclusive/exclusive criteria, were selected from the Department of Orthopedics, the First Affiliated Hospital of Gannan Medical University, includ- ing 46 males and 27 females, with an average age of （64.40±8.27） years ranged from 46 to 78 years. All patients involved the first revision with an average time of 8.6 years, ranged from 5 to 34 years from primary hip arthroplasty to revision. The causes of revision included aseptic loosening in 46, periprosthetic fractures in 21 and deep infection in 6 patients. Length of incision, operative time, intraoperative blood loss, hospital stay, the bedrest time, complications and Harris scores were evaluated re- spectively. The stability of the prosthesis and bone ingrowth were determined according to the radiographic observation. [Results] All patients were followed up for an average of （20.21±4.21） months （8 to 36 months） . The average length of incision was （10.52±2.67） cm in the aseptic loosening group, （14.82 ± 3.18）cm in the periprosthetic fractures group and （9.84±2.24） cm in the deep infection group respectively （F=18.47, P〈0.01）. Correspondingly, operation time was 163.25 ± 12.74 rain, 187.30± 18.85 min and 127.35 ± 10.27 minutes （F=43.89, P〈0.01） . Intraoperative blood loss was （382.52±47.53） ml, （427.67±61.72） roland （317.83±28.49） ml （F=12.24, P〈0.01） . Hospital stay was （10.40±3.35） days, （16.31±4.43） days and （10.84±2.36） days （F=19.46, P〈0.01）. Additionally, bedrest time was （24.12±9.75） days, （38.41±12.43） days and （31.79±7.39） days individually （F=13.74, P〈0.01 ） . Harris scores were significantly im- proved comparing those preoperatively with these at the latest follow up, （46.89±8.63） versus （85.76±6.48） in the aseptic loosening group （t=24.43, P〈0.01）, （45.90±7.98） versus （83.90±6.27） in the periprosthetie fractures group （t=17.16, P〈0.01）, and （48.12±7.22） versus （88.67±5.79） in the deep infection group （t=10.73, P〈0.01） . However, there were no differences among three groups in Harris scores at the last follow-up （F=1.44, P〉0.05） . All patients achieved primary healing of incision without complications such as infection, deep venous thrombosis and nerve injury. Furthermore, no pros- thetic loosening or subsidence, infection or bone absorption around the implant was observed by images in any patient during the follow-up period. [Conclusion] The short-term clinical outcomes show satisfactory improvement of hip function in hip re- vision using long-stem cementless prosthesis, however, further follow-up is required for long-term results.
作者
黄世桥
何春耒
陈震东
高辉
HUANG Shi-qiao HE Chun-lei CHE Zhen-dong et al(Departrnent of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China.)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第8期709-713,共5页
Orthopedic Journal of China
关键词
翻修
生物型翻修加长柄
无菌性松动
Revision, long-stem eementless prosthesis, aseptic loosening
