【作者】 杨述华； 吴星火； 许伟华； 叶树楠； 杨操； 李进； 刘先哲；

【Author】 Xinghuo Wu,Yang Shu -hua,Xu Wei -hua,Ye Shu -nan,Yang Cao,Li Jin,Xianzhe Liu.Orthopedic Department of Union Hospital,Tongji Medical Collage,Huazhong university of Science and Technology,Wuhan hubei 430022,China

【机构】 华中科技大学同济医学院附属协和医院骨科；

【摘要】 目的。随着第一代人工股骨头和人工髋关节使用寿命的到期,目前国内外全髋关节翻修的患者日渐增多。本研究旨在金属—聚乙烯假体置换术后翻修原因,探讨髋臼翻修技术及疗效。方法16例一期行金属—聚乙烯假体置换术后患者,髋臼翻修固定方式包括非骨水泥型和骨水泥型,其中8例行异体颗粒骨打压植骨结合使用金属网重建髋臼。所有患者均进行临床和影像学随访。结果髋臼翻修16例,股骨柄翻修10例。所有病例均获得随访,平均随访时间为5.9±1.8年。关节翻修术后所有患者的HHS评分优,平均HHS评分由术前的68分(62-75分)升高91分(90-94分),所有病例在随访中均没有出现假体旁透亮线、假臼水平或垂直移位和骨溶解等征象。本组并发症发生4例,异位骨化2例,脱位2例,没有感染病例发生。结论聚乙烯衬垫离解是全髋关节置换术越来越常见的并发症,会导致骨溶解和假体松动发生。因假体松动而施行全髋翻修术患者,几乎都伴有不同骨缺损。髋臼缺损的处理依赖于患者的局部和全身情况,有效修复骨缺损,进行髋部骨性结构的重建,是翻修术成败关键。更多还原

【Abstract】 Objective The purpose of the current study was to evaluate revision techniques and clinical results and present problems of the "classic" metal - on - polyethylene bearing surfaces used in THA.Methods We reported a serises of 16 patients with metal - on - polyethylene THA who came to our hospital for revision surgery and evaluate the clinical and radiographic results of press - fit cup(cementless) and Impaction bone grafting plus titanium mesh(cement) in revision surgery from December 1990 to June 1999.Patients were evaluated with an interview focusing on clinical and radiologic examination.Results Acetabular revision were done in all 16 patients,while femoral stems were revised in 10 hips(62.5%) with loosening of the stems or extensive osteolyric lesions.All the patients were followed up.The mean duration of follow - up monitoring after revision THA was 5.9±1.8 years.For all patients,the average HHS score once again improved from 68 points(range,62-75 points to 91 points(range,90 -94 points)excellent,,after revision surgery.There were no hips with radiolucent lines,vertical or horizontal acetabular cup migration, or osteolysis during the follow - up period.Complicatious were observed in 4 hips:2 heterotopic ossifications,2 dislocations. There were no deep wound infections.Conclusion Dissociation of the polyethylene liner is an increasingly common complica- tion after THA,which will cause pelvic osteolysis and implant loose and subsequently revision of the implant.The choices for revision fixation include cementless and cemented components.Treatment of acetabular defects depends on the general and local condition, aiming to reconstruct bone defects,provide stability and support for implants.更多还原