年轻患者初次髋关节置换术后关节翻修的原因分析

doi:10.3877/cma.j.issn.1674-134X.2023.03.020

目的

分析40岁之前接受初次全髋置换的患者行髋关节翻修的主要原因，并与老年患者(年龄≥60岁)的翻修原因对比。

方法

回顾性分析2005年1月至2020年10月在南昌市洪都中医院接受髋关节翻修术的156例(年轻组76例，老年组80例)患者(188例髋关节)，明确患者行髋关节翻修的原因、两次手术间隔的时间和需要翻修的部分是否有区别。卡方检验分析翻修部分与初始固定方式(骨水泥或非骨水泥固定)的关系。

结果

年轻患者初次置换术后至翻修手术的平均间隔时间为(11±5)年，行初次全髋置换最常见的病因分别是：股骨头缺血性坏死、发育性髋关节发育不良、创伤性关节炎和青少年特发性关节炎。年轻患者行髋关节翻修的主要原因是：髋臼假体松动(29.4%)、聚乙烯内衬磨损(20.6%)和股骨假体松动(18.6%)。老年患者髋关节翻修的最常见的原因分别是：术后脱位(26.7%)、感染(20.9%)、髋臼假体松动(16.3%)。在年轻患者中，假体松动需翻修的部分与初始固定方式的差异无统计学意义(χ²＝0.146，P>0.05)。

结论

髋臼假体松动、聚乙烯磨损和股骨假体松动是年轻患者翻修的常见原因；与高龄患者翻修原因相比，术后脱位和感染的发生率较低。

关键词: 关节成形术，置换，髋, 再手术, 假体失效, 关节不稳定性

Objective

To analyze the main causess for hip revision in patients who have primary total hip replacement(THA) under 40 years old, and to compare with the elderly (age≥60 years).

Methods

A retrospective analysis was conducted on 156 patients (76 in the young group and 80 in the elderly group) who underwent revision hip arthroplasty at Nanchang Hongdu Hospital of Traditional Chinese Medicine from January 2005 to October 2020. Clinical data of 188 hip joints (102 hips in the young group and 86 hips in the elderly group) were collected to clarify the reasons for hip revision, the time between two operations, and the difference in the revision part. Chi-square test was applied to analyze the relationship between revision parts and the fixation methods of primary THA (bone cement or cementless prostheses).

Results

The average interval between primary THA and revision surgery in the young group was(11±5)years. The most common causes of primary THA were: avascular necrosis of the femoral head, developmental dysplasia of the hip, traumatic arthritis and juvenile idiopathic arthritis. The causes for hip revision in the young group were: acetabular prosthesis loosening(29.4%), polyethylene liner wear(20.6%)and femoral prosthesis loosening(18.6%). The most common reasons for revision in the elderly group were: postoperative dislocation(26.7%), infection(20.9%), and loosening of the acetabular prosthesis(16.3%). In the young group, the revision part of prosthesis was not related to the fixation method in primary THA (χ²=0.146, P>0.05).

Conclusions

After primary THA, acetabular prosthesis loosening, polyethylene wear and femoral prosthesis loosening are the common causes of revision in young patients; while the incidences of postoperative dislocation and infection are lower in the youth than that in the elderly.

Key words: Arthroplasty, replacement, hip, Reoperation, Prosthesis failure, Joint, instability

表1 研究人群的人口统计特征

Table 1 Demographic characteristics of the study population

组别Groups	例数Number of cases	初次THA至翻修手术时间[年，(±s)]Interval between primary THA and revision surgery	女性Female	使用糖皮质激素或生物制剂Glucorticoids or biologics
组别Groups	例数Number of cases		女性Female	是Yes	否None	未记录No record
青年组Young group	76	11±5	46	28	40	8
老年组Elderly group	80	7±6	38	17	50	13
统计值		t＝2.017	χ²＝2.661	χ²＝4.891
P值		<0.05	>0.05	>0.05

表1 研究人群的人口统计特征

Table 1 Demographic characteristics of the study population

组别Groups	例数Number of cases	初次THA至翻修手术时间[年，(±s)]Interval between primary THA and revision surgery	女性Female	使用糖皮质激素或生物制剂Glucorticoids or biologics
组别Groups	例数Number of cases		女性Female	是Yes	否None	未记录No record
青年组Young group	76	11±5	46	28	40	8
老年组Elderly group	80	7±6	38	17	50	13
统计值		t＝2.017	χ²＝2.661	χ²＝4.891
P值		<0.05	>0.05	>0.05

图1 青年组按初始诊断分层的翻修原因注：AVN-股骨头缺血性坏死坏死；DDH-发育性髋关节发育不良；PTA-创伤后关节炎；OA-骨性关节炎；RA-类风湿关节炎

Figure 1 Causes for revision surgery in the young group stratified by primary diagnosis

图2 老年组按初始诊断分层的翻修原因注：AVN-股骨头缺血性坏死坏死；DDH-发育性髋关节发育不良；PTA-创伤后关节炎；OA-骨性关节炎；RA－类风湿关节炎

Figure 2 Causes for revision surgery in the elderly group stratified by primary diagnosis

表2 两组患者髋关节翻修原因的对比分析[例(%)]

Table 2 Comparative analysis of the reasons for hip joint revision between two groups

组别Groups	例数Number of cases	翻修原因
组别Groups	例数Number of cases	髋臼假体松动Loosening of acetabular prosthesis	股骨假体松动Loosening of femoral prosthesis	感染Infection	脱位Dislocation	聚乙烯磨损Wearing of polyethylene	假体周围骨折Periprosthetic fractures	全髋假体松动Loosening of total prostheses
青年组Young group	76	30(29.4)	19(18.6)	8(7.8)	13(12.7)	21(20.6)	5(4.9)	6(5.9)
老年组Elderly group	80	14(16.3)	7(8.1)	18(20.9)	23(26.7)	8(9.3)	11(12.8)	5(4.8)
χ²值				24.968
P值				<0.001

表2 两组患者髋关节翻修原因的对比分析[例(%)]

Table 2 Comparative analysis of the reasons for hip joint revision between two groups

组别Groups	例数Number of cases	翻修原因
组别Groups	例数Number of cases	髋臼假体松动Loosening of acetabular prosthesis	股骨假体松动Loosening of femoral prosthesis	感染Infection	脱位Dislocation	聚乙烯磨损Wearing of polyethylene	假体周围骨折Periprosthetic fractures	全髋假体松动Loosening of total prostheses
青年组Young group	76	30(29.4)	19(18.6)	8(7.8)	13(12.7)	21(20.6)	5(4.9)	6(5.9)
老年组Elderly group	80	14(16.3)	7(8.1)	18(20.9)	23(26.7)	8(9.3)	11(12.8)	5(4.8)
χ²值				24.968
P值				<0.001

图3 初次THA(全髋关节置换)术后髋臼侧假体无菌性松动翻修前后双髋关节X线片。图A为双髋关节正位片，示侧人工全髋关节置换术后髋臼假体松动，患侧肢体短缩；图B为术后复查双髋正位片，示术后翻修假体固定牢靠，双下肢基本等长

Figure 3 Anterio-posterior views of bilateral hips of X rays before and after the revision surgery of aseptic prosthetic loosening on the acetabular side after the primary THA. A is the X ray image before the revision surgery, showing the loosening of the acetabular prosthesis and shortening of the affected limb after the right primary THA; B is the X ray image after the revision surgery, showing the revised prosthesis was firmly fixed and both lower limbs were equal in length.

表3 青年组假体初始固定方式与假体翻修部位(例)

Table 3 Primary fixation methods of prostheses in the young group and the revision parts

固定方式Fixation methods	例数Number of cases	翻修的部位Revision parts
固定方式Fixation methods	例数Number of cases	髋臼侧Acetabular side	股骨侧Femoral side	全髋Total hip prostheses
股骨和髋臼侧均生物型Cementless components on both sides	31	19	10	2
髋臼侧生物型+股骨侧水泥型Cementless acetabular component + cemented femoral component	20	8	9	3
髋臼和股骨侧均水泥型Cemented components on both sides	4	3	0	1
χ²值		0.146
P值		>0.05

表3 青年组假体初始固定方式与假体翻修部位(例)

Table 3 Primary fixation methods of prostheses in the young group and the revision parts

固定方式Fixation methods	例数Number of cases	翻修的部位Revision parts
固定方式Fixation methods	例数Number of cases	髋臼侧Acetabular side	股骨侧Femoral side	全髋Total hip prostheses
股骨和髋臼侧均生物型Cementless components on both sides	31	19	10	2
髋臼侧生物型+股骨侧水泥型Cementless acetabular component + cemented femoral component	20	8	9	3
髋臼和股骨侧均水泥型Cemented components on both sides	4	3	0	1
χ²值		0.146
P值		>0.05

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Factors analysis on revision surgery after total hip replacement in young patients

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Factors analysis on revision surgery after total hip replacement in young patients