Shen Bin, Yang Jing, Pei Fu-xing
Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, China.
Zhonghua Wai Ke Za Zhi. 2006 Oct 15;44(20):1407-10.
To investigate the surgical indications and surgical techniques of revision total hip arthroplasty for the failed hemiarthroplasty.
From June 1997 to June 2000, 56 cases (31 males and 25 females) of failed hemiarthroplasty received the revision total hip arthroplasty. The age was from 64 - 75 years (mean 68 years). Among them, there were 29 cases with acetabular erosion, 14 cases with acetabular erosion and central dislocation of femoral head, 12 cases with stem loosening and 1 case with stem fracture. All the cases were revised in one stage, and bone grafts were adopted when necessary.
Forty-nine cases were followed up for 5 - 8 years (mean, 7 years), and 7 cases had lost. The mean Harris score increased from 37 (rang, 28 - 40) preoperatively to 88 (rang, 84 - 90) at last follow-up. No wound infection and neurovascular injury happened. Only 5 perioperative complications occurred, including 3 deep venous thrombosis, 1 dislocation and 1 cortical fracture. No cups or femoral stems needed re-revision. Radiographic analysis showed that the position of the artificial prosthesis was unchanged, and no loosening sign existed.
The acetabular erosion and central dislocation of femoral head are the main reasons for revision total hip arthroplasty after hemiarthroplasty. The medium-term follow-up results show that the clinical effects are encouraging if the surgical indications and surgical techniques are suitable.
探讨半髋关节置换失败后翻修全髋关节置换术的手术适应证及手术技术。
1997年6月至2000年6月，56例（男31例，女25例）半髋关节置换失败患者接受了翻修全髋关节置换术。年龄64 - 75岁（平均68岁）。其中髋臼磨损29例，髋臼磨损合并股骨头中心脱位14例，股骨柄松动12例，股骨柄骨折1例。所有病例均一期翻修，必要时采用植骨。
49例获5 - 8年（平均7年）随访，失访7例。末次随访时Harris评分平均由术前37分（范围28 - 40分）提高至88分（范围84 - 90分）。无伤口感染及神经血管损伤发生。围手术期仅发生5例并发症，包括3例深静脉血栓形成、1例脱位和1例皮质骨骨折。无髋臼杯或股骨柄需要再次翻修。影像学分析显示人工假体位置无改变，无松动征象。
髋臼磨损及股骨头中心脱位是半髋关节置换术后翻修全髋关节置换术的主要原因。中期随访结果表明，若手术适应证及手术技术合适，临床效果令人满意。
