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中华关节外科杂志(电子版)

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:
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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]. 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]. 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。

关键词: 关节成形术, 置换, 髋, 再手术, 髋假体, 股骨
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.

Key words: Arthroplasty, replacement, hip, Reoperation, Hip prosthesis, Femur
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
例数 年龄[岁，(±s)] 性别(例，男/女) 部位(例，左/右) 初次手术时间[年，(±s)]
对照组 52 66.2±4.8 31/21 17/35 7.4±1.8
观察组 52 66.7±5.1 32/20 15/37 7.6±1.4
统计值 t ＝0.381 χ2＝0.040 χ2＝0.181 t＝0.655
P值 >0.05 >0.05 >0.05 >0.05
表2 生物型翻修加长柄观察组与对照组手术指征比较(±s)
组别 例数 手术时间(min) 术中出血量(ml) 住院时间(d) 骨折愈合时间(月)
对照组 52 52.6±7.9 216.4±37.0 20.7±1.2 10.6±1.4
观察组 52 51.2±8.4 213.8±31.5 17.3±0.9 9.3±1.0
t值 1.273 0.952 4.917 4.398
P值 >0.05 >0.05 <0.01 <0.01
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)]
组别 例数 疼痛 功能 关节活动度 畸形 总评分
治疗前 随访时 治疗前 随访时 治疗前 随访时 治疗前 随访时 治疗前 随访时
对照组 52 19.2±1.5 35.7±3.4a 21.3±2.0 33.8±4.1b 2.3±0.4 3.1±0.3c 2.1±0.3 2.8±0.2d 44.9±8.5 75.4±9.6e
观察组 52 19.0±1.7 41.8±1.6f 21.5±1.8 43.1±0.7g 2.4±0.3 3.8±0.4h 2.1±0.2 3.5±0.3i 45.0±9.2 92.2±4.1j
t值 0.337 4.709 0.319 6.032 1.007 5.258 0.369 5.508 0.043 5.267
P值 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01
表4 生物型翻修加长柄观察组与对照组远期疗效比较[例(%)]
组别 例数 优 良 中 差 优良情况
对照组 52 7(13.5) 16(30.8) 28(53.8) 1(1.9) 23(44.2)
观察组 52 38(73.1) 13(25.0) 1(1.9) 0(0.0) 51(98.1)
χ2值 - - - - 36.728
P值 - - - - <0.01
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)]
组别 例数 VAS评分 ADL评分 QOL评分
治疗前 随访时 治疗前 随访时 治疗前 随访时
对照组 52 7.8±0.5 1.4±0.3a 27.6±5.2 68.9±4.7b 37.1±8.3 82.7±4.1c
观察组 52 7.7±0.6 0.9±0.2e 27.4±6.0 83.6±5.9f 37.5±7.8 90.2±5.4g
t值 0.911 8.561 0.242 5.205 0.278 3.976
P值 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01
表6 生物型翻修加长柄观察组与对照组并发症比较[例(%)]
组别 例数 切口感染 下肢深静脉血栓 骨水泥危象 股骨假体周围骨折 关节脱位 并发症
对照组 52 2(3.8) 1(1.9) 2(3.8) 1(1.9) 1(1.9) 7(13.5)
观察组 52 1(1.9) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 1(1.9)
χ2值 - - - - - 4.875
P值 - - - - - <0.05
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