切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 430 -434. doi: 10.3877/cma.j.issn.1674-134X.2023.03.020

临床经验

年轻患者初次髋关节置换术后关节翻修的原因分析
皮颖, 王高, 张强, 黄志荣()   
  1. 330000 南昌,江西中医药大学附属洪都中医院
  • 收稿日期:2021-04-25 出版日期:2023-06-01
  • 通信作者: 黄志荣

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

Ying Pi, Gao Wang, Qiang Zhang, Zhirong Huang()   

  1. Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, China
  • Received:2021-04-25 Published:2023-06-01
  • Corresponding author: Zhirong Huang
引用本文:

皮颖, 王高, 张强, 黄志荣. 年轻患者初次髋关节置换术后关节翻修的原因分析[J/OL]. 中华关节外科杂志(电子版), 2023, 17(03): 430-434.

Ying Pi, Gao Wang, Qiang Zhang, Zhirong Huang. Factors analysis on revision surgery after total hip replacement in young patients[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 430-434.

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。

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.

表1 研究人群的人口统计特征
Table 1 Demographic characteristics of the study population
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
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
[1]
Kaneko S, Takegami Y, Seki T, et al. Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan[J]. Int Orthop, 2020, 44(4): 761-769.
[2]
Khatod M, Barber T, Paxton E, et al. An analysis of the risk of hip dislocation with a contemporary total joint registry[J]. Clin Orthop Relat Res, 2006, 447:19-23.
[3]
Tsukanaka M, Halvorsen V, Nordsletten L, et al. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old[J]. Acta Orthop, 2016, 87(5): 479-484.
[4]
Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis[J]. Int Orthop, 2010, 34(8): 1123-1127.
[5]
Firestone DE, Callaghan JJ, Liu SS, et al. Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component. A follow-up study at a minimum of ten years[J]. J Bone Joint Surg Am, 2007, 89(1): 126-132.
[6]
Bozic KJ, Kamath AF, Ong K, et al. Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA[J]. Clin Orthop Relat Res, 2015, 473(6): 2131-2138.
[7]
Zhang L, Zhou YX, Zhou XH, et al. Analysis of the failure mechanisms of the revision hip arthroplasties[J]. Chin J Surg, 2009, 47(3): 164-167.
[8]
Guo SJ, Zhou YX, Zhang L, et al. An investigation on failure mechanisms of primary 327 hip arthroplasties[J]. Chin J Surg, 2009, 47(3): 168-171.
[9]
Grübl A, Chiari C, Gruber M, et al. Cementless total hip arthroplasty with a tapered,rectangular titanium stem and a threaded cup:a minimum ten-year follow-up[J]. J Bone Joint Surg Am, 2002, 84(3): 425-431.
[10]
Solomon MI, Dall DM, Learmonth ID, et al. Survivorship of cemented total hip arthroplasty in patients 50 years of age or younger[J]. J Arthroplasty, 1992, 7 Suppl: 347-352.
[11]
Cordtz RL, Zobbe K, Højgaard P, et al. Predictors of revision,prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis:a nationwide cohort study using Danish healthcare registers[J]. Ann Rheum Dis, 2018, 77(2): 281-288.
[12]
Johnson AJ, Mont MA, Tsao AK, et al. Treatment of femoral head osteonecrosis in the United States: 16-year analysis of the Nationwide Inpatient Sample[J]. Clin Orthop Relat Res, 2014, 472(2): 617-623.
[13]
Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty:an analysis of risk factors and treatment options[J]. J Bone Joint Surg Am, 2002, 84(10): 1788-1792.
[14]
Prodinger PM, Schauwecker J, Mühlhofer H, et al. Hip dislocation after revision arthroplasty:Risk assessment and treatment strategies[J]. Orthopade, 2017, 46(2): 133-141.
[15]
Nilsdotter AK, Lohmander LS, Klässbo M, et al. Hip disability and osteoarthritis outcome score (HOOS) - validity and responsiveness in total hip replacement[J/OL]. BMC Musculoskelet Disord, 2003, 4: 10. DOI: 10.1186/1471-2474-4-10.
[1] 郭艳波, 马亮, 李刚, 阎伟, 骆帝, 岳亮, 吴伟山. 全膝关节置换术后胫股关节脱位的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 658-671.
[2] 丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[3] 孔德铭, 刘铮, 李睿, 钱文伟, 王飞, 蔡道章, 柴伟. 人工智能辅助全髋关节置换三维术前规划准确性评价[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 431-438.
[4] 高小康, 张净宇, 刘金伟, 田东牧, 胡永成, 徐卫国. 连接型人工膝关节假体运动和负重模式的演变和进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 505-516.
[5] 刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[6] 刘晓凡. 老年股骨头坏死髋关节置换术后康复应用多维度干预[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 314-319.
[7] 钟向娣, 任婷婷, 任丽, 刘梦碟, 周娅颖, 游月梅, 张琳玲. 全髋关节置换护理的可视化分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 256-263.
[8] 卢国良, 潘耀成. 比较不同类型假体用于骨质疏松症的老年股骨颈骨折[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 277-279.
[9] 肖志满, 庄锡琪, 龚煜. 关节镜下Lasso-loop Gould术式治疗踝关节外侧不稳定的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 280-284.
[10] 谭飞, 乔永杰, 张浩强, 庄凯鹏, 曾健康, 李嘉欢, 李培杰, 李栋栋, 王静, 周胜虎. 磨损颗粒影响破骨细胞经典信号通路研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 106-117.
[11] 潘韩丽, 何静, 陈媛媛, 贾梦瑶, 赵兴, 杨佩. 机器人辅助全髋关节置换围手术期应用加速康复护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 142-146.
[12] 金鑫, 谢卯, 刘芸, 杨操, 杨述华, 许伟华. 个性化股骨导向器辅助初次全髋关节置换的随机对照研究[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 780-787.
[13] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[14] 王增萌, 彭春辉, 吴东阳, 王凯, 闫俊, 黄心洁, 陈亚军. 先天性胆总管囊肿术后吻合口狭窄/肝内胆管结石的腹腔镜再手术经验[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(02): 111-115.
[15] 陈逍堃, 竺枫, 何信坤, 包丞州, 阮健. 同种异体肌腱双束重建肘关节外侧韧带治疗肘关节慢性后外侧旋转不稳定的临床疗效[J/OL]. 中华肩肘外科电子杂志, 2024, 12(02): 140-146.
阅读次数
全文
8
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 2 0 0 6

  来源 本网站 其他网站
  次数 4 4
  比例 50% 50%

摘要
128
最新录用 在线预览 正式出版
0 0 128
  来源 本网站 其他网站
  次数 16 112
  比例 12% 88%