[股骨前开窗在髋关节翻修置换术中的应用经验]

Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing 100044, China.

Zhonghua Wai Ke Za Zhi. 2012 May;50(5):398-401.

OBJECTIVE

To discuss the clinical results of anterior windowing of the femur to remove the femoral component and cement in revision total hip arthroplasty.

METHODS

From September 1999 to May 2011, 31 revision cases received anterior windowing of the femur in operation. There were 12 male and 19 female, with the average age in operation was 61.8 years (from 40 to 83 years). The reason for revision included aseptic loosening in 12 cases, infection in 4 cases, breakage of femoral stem in 11 cases and acetabular liner wear in 4 hemi-arthroplasties. Nine cases were cemented and 22 were non-cemented for the primary stem. The position of the window located in the anterior femur with 6 cases of complete windowing from the proximal to the end of the stem. Another 25 cases received regional windowing just around the tip of the stem. In revisions, non-cemented rectangular revision stem were used for 27 cases and two-stage surgery were used for 4 infection cases.

RESULTS

In all revisions, femoral stems and cement fragments were removed successfully and safely without any complications of fracture and perforation of new stems. All femur windows showed successfully union for average 14 weeks (12-18 weeks). There were some postoperative complications. One recurrent dislocation was treated using plaster external fixation for 8 weeks. One case with dislocation and fracture along with the window was revised by cerclage fixation. One periprosthetic fracture due to trauma was treated by cerclage fixation. The average Harris score of the hip improved to 83 points (75 to 90 points) at an average 5.5 years follow-up (0.5 to 12.0 years). Twenty six cases were completely followed up. Revision femoral stems were well-fixed without any subsidence or loosening.

CONCLUSIONS

Anterior windowing of the femur is a proven technique which can be used to remove femoral stem and cement conveniently and safely without any fractures in revision total hip arthroplasty.

目的

探讨股骨前开窗在翻修全髋关节置换术中取出股骨假体及骨水泥的临床效果。

方法

1999年9月至2011年5月，31例翻修病例在手术中采用股骨前开窗。其中男性12例，女性19例，平均手术年龄61.8岁（40至83岁）。翻修原因包括无菌性松动12例、感染4例、股骨干骨折11例以及4例半髋关节置换术中髋臼衬垫磨损。初次假体9例为骨水泥型，22例为非骨水泥型。开窗位置位于股骨前方，6例从假体近端至末端完全开窗，另外25例仅在假体末端周围局部开窗。翻修术中，27例使用非骨水泥矩形翻修假体，4例感染病例采用二期手术。

结果

所有翻修病例均成功、安全地取出了股骨假体和骨水泥碎片，未出现新假体骨折及穿孔等并发症。所有股骨开窗平均14周（12至18周）均成功愈合。术后有一些并发症。1例复发性脱位采用石膏外固定8周。1例伴有开窗处脱位和骨折的病例采用环扎固定进行翻修。1例因创伤导致的假体周围骨折采用环扎固定治疗。平均随访5.5年（0.5至12.0年）时，髋关节Harris评分平均提高至83分（75至90分）。26例获得完整随访。翻修股骨假体固定良好，无下沉或松动。