| 组配式生物型股骨柄在复杂髋翻修中的应用 |
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Received:December 16, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张振东 |
ZHANG Zhen-dong |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 卓奇 |
ZHUO Qi |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 张庆猛 |
ZHANG Qing-meng |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 宋俊雷 |
SONG Jun-lei |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 杨帆 |
YANG Fan |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
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| 陈继营 |
CHEN Ji-ying |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, China |
chenjiying_301@163.com |
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| 期刊信息：《中国骨伤》2015年28卷，第3期，第198-204页 |
| DOI：10.3969/j.issn.1003-0034.2015.03.002 |
| 基金项目:国家自然科学基金青年科学基金项目(编号:81201404) |
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目的:探讨组配式生物型股骨柄MP假体应用于复杂髋翻修的手术技术要点及疗效。
方法:回顾性分析2002年1月至2013年12月行MP假体翻修的患者,共246例获得随访,男148例,女98例;年龄26～83岁,平均62.5岁。术后随访0.5～11年,平均5.7年。翻修原因:无菌松动107例,髋关节置换术后感染104例,其他35例有不明原因疼痛、假体周围骨折、磨损及脱位等。根据Paprosky分型,股骨骨缺损Ⅰ型14例,Ⅱ型39例,ⅢA型171例,ⅢB型22例。术前髋关节Harris评分37.4±7.5.随访患者行影像学检查、临床疗效评估及主观满意度调查。
结果:随访时Harris评分提升至87.8±4.2,高于术前(t=92.13,P=0.00).双下肢长度、术后稳定性及患者总体主观满意度结果:非常满意分别为27、60及61例。最常见的并发症为骨折29例,其中术中21例,术后8例;其他并发症包括感染7例,脱位5例,坐骨神经不全损伤所致患肢麻木6例、肿胀3例。随访X线显示4例假体下沉(>1 cm),其中2例翻修。
结论:MP假体用于复杂髋翻修(尤其是股骨近端严重骨缺损)患者,远、近期随访效果良好,且用于感染翻修成功率高。为避免并发症,提高手术效果,术中需要仔细操作,掌握适应证及手术技术要点。 |
| [关键词]:关节成形术,置换,髋 假体植入 手术后并发症 髋关节 |
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| Application of modular cementless femoral stems in complex revision hip arthroplasty |
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Abstract:
Objective:To investigate and clarify the key surgical techniques and evaluate clinical effectiveness of modular cementless femoral stems(LINK MP modular stem) in complex revision hip arthroplasty.
Methods:From January 2002 to December 2013,470 patients in Chinese PLA General Hospital received revision hip arthroplasties using MP stems. Among them,246 patients were followed for an average of 5.7 years(ranged,0.5 to 11 years). There were 148 males and 98 females,with an average age of 62.5 years old(ranged from 26 to 83 years old). The most common reason for revision was aseptic loosening of femoral stems (107 cases,43.5%),followed by prosthetic joint infection (104 cases,42.3%). Other reasons included unexplained hip or thigh pain,periprosthetic femoral fracture,prosthesis wear and dislocation. According to Paprosky classification of femoral deficiency,there were 171 cases of type ⅢA(69.5%),14 cases of typeⅠ,39 cases of typeⅡ,and 22 cases of type ⅢB. The average preoperative Harris hip score(HHS) was 37.4±7.5. In addition,radiographic presentation,degree of patients' subjective satisfaction,and clinical effectiveness were assessed as well.
Results:The average Harris score was improved to 87.8±4.2 after operation,with significant statistical difference when compared to preoperative score(t=92.13,P=0.00). Analysis of patients' subjective satisfaction for leg length discrepancy,stability and overall degree of satisfaction showed that the number of patients with great satisfaction were 27,60,61 respectively. The most common complication was the periprosthetic fracture (intraoperatively 21 cases and postoperatively 8 cases). Other complications included infection (7 cases),dislocation (5 cases),numbness possibly caused by incomplete sciatic nerve injury (6 cases) and thigh swelling (3 cases). The X-ray taken at the final follow-up revealed that prosthesis subsidence occurred in 4 cases,2 of which needed a second revision.
Conclusion:The application of modular cementless femoral stems (LINK MP modular stem) in complex revision hip arthroplasty (especially in cases with the serious defect of proximal femoral bone) shows good results at both the short-term and long-term follow-up,especially in the revision for prosthetic infection with the high success rate. In order to avoid complications and improve clinical outcomes,the surgeons should carefully select proper surgery candidates,perform the procedure with care,and master the key surgical techniques. |
| KEYWORDS:Arthroplasty,replacement,hip Prosthesis,implantation Postoperative complications Hip joint |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张振东,卓奇,张庆猛,宋俊雷,杨帆,陈继营.组配式生物型股骨柄在复杂髋翻修中的应用[J].中国骨伤,2015,28(3):198~204 |
| 英文格式: | ZHANG Zhen-dong,ZHUO Qi,ZHANG Qing-meng,SONG Jun-lei,YANG Fan,CHEN Ji-ying.Application of modular cementless femoral stems in complex revision hip arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):198~204 |
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