中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (43): 8158-8161.doi: 10.3969/j.issn.1673-8225.2010.43.044

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

人工双动股骨头置换后近期脱位全髋关节翻修：同一机构13年143例置换者中的5例翻修　

孟伟正，张  勇，王明君，呼  兵，陈明国，郑永茂，党丽萍，何  香   

  1. 河南平顶山煤业集团总医院，河南省平顶山市 473000
  • 出版日期:2010-10-22 发布日期:2010-10-22
  • 作者简介:孟伟正★，男，1971年生，河南省方城县人，汉族，2005年昆明医学院毕业，硕士，主治医师，主要从事骨关节外科、创伤骨科的研究。 mwz7788@126.com
  • 基金资助:

    河南平顶山煤业(集团)有限责任公司科技开发项目基金(41040320091113)。

Total hip revision for early dislocation following double-action femoral head replacement: A five-case follow-up in 13 years in one institute

Meng Wei-zheng, Zhang Yong, Wang Ming-jun, Hu Bing, Chen Ming-guo, Zheng Yong-mao, Dang Li-ping, He Xiang   

  1. General Hospital of Pingdingshan Coal Industry (Group) Co. Pingdingshan  473000, Henan Province, China
  • Online:2010-10-22 Published:2010-10-22
  • About author:Meng Wei-zheng★, Master, Attending physician, General Hospital of Pingdingshan Coal Industry (Group) Co. Pingdingshan 473000, Henan Province, China mwz7788@126.com
  • Supported by:

     the Science and Technology Development Program of Pingdingshan Coal Industry (Group) Co. No. 41040320091113*

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摘要：

背景：前期文献对人工双动股骨头置换后翻修原因的分析主要集中在假体松动下沉、髋臼磨损、假体柄断裂等方面，有关置换后近期脱位翻修的报道较少。
目的：分析人工双动股骨头置换后近期脱位的原因，探讨行人工全髋关节置换翻修的必要性。
方法：回顾性分析1995-05/2008-10行人工双动股骨头置换后全髋关节翻修5例患者的临床资料，男3例，女2例，年龄75~87岁，平均81岁。翻修原因均为置换后近期脱位，所有病例均一期翻修，有骨质缺损者同时植骨。翻修后早期观察血常规及血沉变化；翻修后6个月，1，2年评估髋关节Harris评分；以X射线平片观察骨盆前后位髋臼假体位置。　
结果与结论：所有患者翻修后获得至少1年(1~4年)随访，无一例需要再翻修，末次随访Harris评分平均88分。全部病例翻修后无伤口感染和神经血管损伤。扩髓时骨皮质不全骨折1例，X射线片显示人工关节假体位置正常，无松动感染征象。提示手术技巧不当及病例选择不当为人工双动股骨头置换后近期脱位的主要原因。由于双动头的双动特点，一旦脱位难以闭合复位，只能行翻修术。若手术指征正确，手术技巧娴熟，全髋翻修手术可以获得良好的临床效果。

关键词: 全髋关节翻修, 双动股骨头假体, 置换, 脱位, 随访

Abstract:

BACKGROUND: Previous studies analyzed prosthesis loosening and subsidence, acetabulum wearing, prosthesis stem breakage in revision following artificial bipolar femoral head replacement. Little is known regarding dislocation-induced revision.
OBJECTIVE: To analyze the causes for early dislocation of artificial bipolar femoral head after total hip replacement and explore the necessity of revision.
METHODS: Clinical data of 5 patients who underwent revision after artificial bipolar femoral head replacement from May 1995 to October 2008 were reviewed retrospectively, including 3 males, 2 females, aged 75 to 87 years, with a mean age of 81 years. The reason of revision was recent dislocation. All cases underwent one-stage revision operation, while those with bone defect had bone graft. Routine blood test and blood sedimentation were observed early after revision; Harris scores for hip joint were evaluated 6 months, 1 and 2 years after revision. X-ray was used to observe acetabular prosthesis position in the pelvis.
RESULTS AND CONCLUSION: All postoperative patients were followed up 1 year at least (1 to 4 years), and no one required revision. The mean Harris score was 88 points at the final follow up. No one had wound infection or nerve and vascular damage. There was one case with insufficient cortical bone fracture while enlarging marrow cavity. X-ray showed that the position of prosthesis was normal, with no signs of loosening or infection.  Poor surgical technique and improper operation indication were main reasons for early postoperative dislocation following bipolar artificial femoral head replacement. Because of the feature of double-action, the closed reduction is difficult while dislocation of artificial femoral head occurs and revision is necessary. When the indication is correct, and surgical skill is proficient, the revision of total hip replacement could get excellent functional outcome.

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