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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 417 -422. doi: 10.3877/cma.j.issn.1674-134X.2020.04.005

所属专题: 骨科学 总编推荐 文献

临床论著

生物型翻修加长柄治疗股骨假体松动伴骨缺损
李伟1,(), 高伟力1, 周泓宇2   
  1. 1. 842000 阿克苏地区,新疆沙雅县人民医院骨科
    2. 842000 乌鲁木齐,新疆维吾尔自治区中医医院骨三科
  • 收稿日期:2019-03-30 出版日期:2020-08-01
  • 通信作者: 李伟

Clinical observation of cementless long-stem hip prosthetic replacement for femoral prosthesis loosening with femoral bone defect

Wei Li1,(), Weili Gao1, Hongyu Zhou2   

  1. 1. Department Orthopaedics, Xinjiang Shaya County People′s Hospital, Aksu Prefecture 842000, China
    2. Department Orthopaedics, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, Urumuchi 842000, China
  • Received:2019-03-30 Published:2020-08-01
  • Corresponding author: Wei Li
  • About author:
    Corresponding author: Li Wei, Email:
引用本文:

李伟, 高伟力, 周泓宇. 生物型翻修加长柄治疗股骨假体松动伴骨缺损[J/OL]. 中华关节外科杂志(电子版), 2020, 14(04): 417-422.

Wei Li, Weili Gao, Hongyu Zhou. Clinical observation of cementless long-stem hip prosthetic replacement for femoral prosthesis loosening with femoral bone defect[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 417-422.

目的

探讨生物型翻修加长柄治疗股骨假体松动伴股骨骨缺损的临床效果。

方法

回顾性分析于2011年1月至2015年1月在新疆沙雅县人民医院关节外科接受髋关节翻修术的患者,选取股骨柄松动并伴有股骨缺损且仅翻修股骨柄假体者,排除感染、髋臼假体问题、严重内科疾病及骨质疏松者,最终纳入病例104例,其中采用生物型翻修加长柄者归入观察组(n=52),采用水泥型翻修柄者归入对照组(n=52)。采用t检验对比分析两组的手术时间、术中出血量、住院时间、骨折愈合时间、相关功能评分。两组优良率、并发症发生率采用卡方检验比较。

结果

两组随访时Harris评分、日常生活能力量表(ADL)评分、生活质量量表(QOL)评分较治疗前增加(对照组:t=10.045、18.185、15.162,均为P<0.05;观察组:t=13.445、23.741、17.324,均为P<0.05)。两组随访时疼痛视觉模拟评分法(VAS评分)较治疗前降低(对照组:t=48.714,P<0.05;观察组:t=78.556,P<0.05)。观察组随访时Harris评分、ADL评分、QOL评分高于对照组(t=5.267、5.205、3.976,均为P<0.05),VAS评分低于对照组(t=8.561,P<0.05),且观察组住院时间、骨折愈合时间更短(t=4.917、4.398,均为P<0.05)。观察组优良率(98.1%)高于对照组(44.2%),并发症发生率(1.9%)低于对照组(13.5%)(χ2=36.728、4.875,均为P<0.05)。

结论

生物型翻修加长柄治疗股骨假体松动伴骨缺损的中期随访效果肯定,是一种可行的假体选择方案,远期疗效尚需进一步观察和验证。

Objective

To investigate the clinical effect of cementless long-stem hip prosthetic replacement for femoral prosthesis loosening with femoral bone defect.

Methods

From January 2011 to January 2015, the patients undergoing hip revision procedures in Xinjiang Shaya County People's Hospital were analysed retrospectively. The patients with femoral handle loose, femoral defect and only revision of femoral prosthesis handle were selected. The patients with infection, problem of acetabulum prosthesis, severe medical diseases and osteoporosis were excluded. A total of 104 cases were enrolled. The patients treated by cementless long-stem hip prosthetic were in the observation group (n = 52). The patients treated by cement hip prosthetic were in the control group (n = 52). The operation time, intraoperative blood loss, hospital stay, fracture healing time and relevant functional scores of the two groups were analyzed by t test. The good rates and incidence of complications were calculated and analyzed by chi-square test.

Results

Harris score, activities of daily living (ADL) score and quality of life (QOL) score were increased in the two groups during the follow-up (control group: t=10.045, 18.185, 15.162, all P<0.05)(observation group: t=13.445, 23.741, 17.324, all P<0.05). The visual analogue scale (VAS) scores in the two groups were lower than those before the treatment (control group: t=48.714, P<0.05) (observation group: t=78.556, P<0.05). During follow-up, Harris score, ADL score and QOL score in the observation group were higher than those in the control group(t=5.267, 5.205, 3.976, all P<0.05), and VAS score was lower than that in the control group (t=8.561, P<0.05). Moreover, the length of hospital stay and fracture healing time in the observation group were shorter(t=4.917, 4.398, both P<0.05). The good rate in the observation group (98.1%) was higher than that in the control group (44.2%), and the complication rate in the observation group (1.9%) was lower than that in the control group (13.5%) (χ2=36.728, 4.875, both P<0.05).

Conclusion

The cementless long-stem hip prosthetic is effective in the treatment of femoral prosthesis loosening with bone defect, and it is a feasible prosthetic option, while the long-term efficacy still needs further observation and verification.

图1 左髋关节翻修术前后骨盆X线正位片。图A为翻修术前,提示假体周围骨折,假体柄松动;图B为翻修术后,采用骨水泥型翻修假体(施乐辉)
图2 髋关节翻修术前后左髋关节X线正位片。图A为翻修术前左髋X线正位片,示假体周围骨折,假体柄松动;图B为翻修术后左髋X线正位片,示采用生物型翻修加长柄(捷迈),并行钢丝捆扎
图3 右髋关节翻修术前后右髋关节X线正位片。图A为翻修术前右髋X线正位片,示假体周围骨缺损,假体柄松动;图B为翻修术后右髋X线正位片,示采用生物型翻修加长柄(捷迈),并行钢丝捆扎
图4 左髋关节翻修术前后骨盆X线正位片。图A为翻修术前骨盆X线正位片,示假体周围骨折,假体柄松动;图B为翻修术后骨盆X线正位片,示采用生物型翻修加长柄(捷迈),并行克氏针张力带固定骨折
表1 一般资料
表2 生物型翻修加长柄观察组与对照组手术指征比较(±s)
表3 生物型翻修加长柄观察组与对照组治疗前、随访时Harris评分比较[分,(±s)]
表4 生物型翻修加长柄观察组与对照组远期疗效比较[例(%)]
表5 生物型翻修加长柄观察组与对照组相关评分比较[分,(±s)]
表6 生物型翻修加长柄观察组与对照组并发症比较[例(%)]
[1]
黄相杰,刘德忠,姜红江.人工髋关节翻修术72例探讨[J/CD].中华关节外科杂志(电子版),2010,4(1):69-73.
[2]
Cip J, Bach C, Widemschek M, et al. Revision of articular surface replacement (ASR) total hip arthroplasty: correlation of perioperative data and early post-revision outcome results[J]. J Arthroplasty, 2015, 30(9): 1607-1617.
[3]
Gwam CU, Mistry JB, Mohamed NS, et al. Current epidemiology of revision total hip arthroplasty in the United States: National inpatient sample 2009 to 2013[J]. J Arthroplasty, 2017, 32(7): 2088-2092.
[4]
Wilches C, Sulbarán JD, Fernández JE, et al. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications[J]. Rev Esp Cir Ortop Traumatol, 2017, 61(2): 111-116.
[5]
Avisar E, Elvey MH, Bar-Ziv Y, et al. Severe vascular complications and intervention following elective total hip and knee replacement:a 16-year retrospective analysis[J]. J Orthop, 2015, 12(3): 151-155.
[6]
查俊俊,孙俊英,王涛,等.生物型组配式锥形柄行全髋关节翻修术的中远期疗效[J/CD].中华关节外科杂志(电子版),2018,12(4):108-112.
[7]
乐国平,张明,周定球,等.生物翻修加长柄在髋关节初次翻修股骨缺损中的应用[J/CD].中华关节外科杂志(电子版),2015,5(5):589-593.
[8]
何爱珊,傅明,盛璞义,等.人工髋关节置换术后5年内翻修的原因分析及处理方法[J].中华外科杂志,2010,48(14):1069-1073.
[9]
Edmunds CT, Boscainos PJ. Effect of surgical approach for total hip replacement on hip function using Harris Hip scores and Trendelenburg's test. A retrospective analysis[J]. Surgeon, 2011, 9(3): 124-129.
[10]
Tashjian RZ, Hung M, Keener JD, et al. Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty[J]. J Shoulder Elbow Surg, 2017, 26(1): 144-148.
[11]
Lima-Costa MF, Mambrini JVM, Torres KCL, et al. Multiple inflammatory markers and 15-year incident ADL disability in admixed older adults: The Bambui-Epigen Study[J]. Arch Gerontol Geriatr,2017,72:103-107.
[12]
Quinti I, Pulvirenti F, Giannantoni P, et al. Development and initial validation of a questionnaire to measure health-related quality of life of adults with common variable immune deficiency: the CVID_QoL questionnaire[J]. J Allergy Clin Immunol Pract, 2016, 4(6): 1169-1179.e4.
[13]
苗绍刚,鲁宁,杨阳,等.全髋关节置换后的股骨假体周围骨折[J].中国组织工程研究,2014,18(4):645-650.
[14]
Tyson Y, Rolfson O, Kärrholm J, et al. Uncemented or cemented revision stems? Analysis of 2,296 first-time hip revision arthroplasties performed due to aseptic loosening, reported to the Swedish Hip Arthroplasty Register[J]. Acta Orthop, 2019, 90(5): 421-426.
[15]
Stambough JB, Xiong A, Baca GR, et al. Preoperative joint space width predicts patient-reported outcomes after total hip arthroplasty in young patients[J]. J Arthroplasty, 2016, 31(2): 429-433.
[16]
Bernard FM, Kavanagh BF. Complications with revision of the femoral component of total hip arthroplasty[J]. J Arthroplasty, 1992, 7(1): 71-79.
[17]
Gehrke T, Gebauer M, Kendoff D. Femoral stem impaction grafting:extending the role of cement[J]. Bone Joint J, 2013, 95-B(11 Suppl A): 92-94.
[18]
王龙强,王黎明,唐成,等.非骨水泥型广泛涂层长柄假体在髋关节翻修股骨轻中度缺损重建中的应用[J].中国组织工程研究与临床康复,2011,15(30):5547-5551.
[19]
Cordero-Ampuero J, Garcia-Rey E, Garcia-Cimbrelo E. Proximal femoral bone regeneration after an uncemented hydroxyapatite-coated long-stem in revision hip surgery[J]. Open Orthop J,2018,12:125-133.
[20]
Yan WY, Julien B, Wen CE. Numerical investigation of the effect of porous titanium femoral prosthesis on bone remodeling[J]. Mater Des, 2011, 32(4): 1776-1782.
[21]
García-Rey E, Cruz-Pardos A, Madero R. The evolution of the technique of impaction bone grafting in femoral revision surgery has improved clinical outcome. A prospective mid-term study[J]. J Arthroplasty, 2015, 30(1): 95-100.
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