摘要
目的探讨全髋关节置换术(THA)治疗化脓性髋关节炎后遗畸形继发骨关节炎的手术并发症及早期疗效观察。方法从2004年至2010年收集本组20例化脓性髋关节炎后遗畸形继发骨关节炎的患者,行THA术的患者,其中男8例,女12例,平均年龄48.5岁。髋关节化脓性感染发生时的平均年龄为10.2岁,从始发感染至行THA的平均间隔时间为34.5年,平均随访时间为3.8年。手术入路包括直接外侧入路(Hardinge入路)10例,后外侧入路10例;采用Kim分类法将髋臼与股骨侧的畸形进行分类,观测假体稳定性及假体周围骨溶解,采用Harris髋评分行术前与术后的临床疗效比较,采用Brooker方法判断异位骨化。结果根据Kim分类法,属于Ⅰ型9例(45%),Ⅱ型4例(20%),Ⅲ型7例(35%)。术中发生股骨骨折3例,1例患者下肢延长4cm后坐骨神经麻痹,无脱位、深静脉血栓形成及感染病例。X线随访结果:髋臼未发现>2mm的移位及外展角的变化;2例在髋臼上方出现>2mm囊性变,提示有骨溶解,2例股骨柄下沉2.5mm,1例股骨柄Gruen2区出现>2mm囊性变,上述患者均无临床不适,予以严密的随访。Harris评分术前平均为46.8分,术后平均为88.5分,有统计学差别(t=12.32,P<0.01)。异位骨化:BrookerⅠ型有2例,Ⅱ型1例。结论 THA是化脓性髋关节炎后遗畸形继发骨关节炎的有效治疗手段,术前严格的病例筛选与评估、良好的手术技术、正确的假体选择是获得术后良好疗效的关键。
Objective To discuss the surgery complications and short-term effectiveness of total hip arthroplasty （THA） for osteoarthritis secondary to hip sequelae of pyogenic infection. Methods From 2004 to 2010, THA was carried out on 20 cases with osteoarthritis secondary, to hip sequelae of pyogenic infection in our division. Eight cases were male and 12 cases were female. The average age was 48.5 years. The average age of infection was 10. 2 years. The interval between active infection and arthroplasty was 34. 5 years. The average follow-up period was 3.8 years. The direct lateral approach （Hardinge＇s approach） was applied in 10 cases and posterolateral approach in the other 10 cases. According to X-ray the acetabular and femoral deformities were classified by Kim＇s classification system and the implant stability and peri-prosthetic osteolysis were evaluated. The clinical effect was measured with Harris hip scoring system pre-operatively and post-operatively. The heterotopic ossification was judged by Brooker method. Results According to Kim＇s classification, nine cases （45%） were type I , four cases （20%） were type II and seven cases （35%） were type m. Femoral fracture occurred in three cases intra- operatively and sciatic nerve palsy occulted in one patient with 4cm leg lengthening post-operatively. No hip dislocation, deep vein thrombosis or infection occurred. From X-ray view, no acetabular implant displacement （ 〉 2 mm） or abduction angle change was tested. The cyst formation （ 〉 2 mm） in the acetabular side occurred in two cases, which indicated osteolysis. The stem subsidence beyond 2. 5 mm occurred in two cases. The cyst formation （ 〉 2 mm） in Gruen 2 area of the femoral stem occurred in one case. All cases abone had no clinical appearance and were closely observed. The average Harris hip score pre-operatively and post-operatively were 46. 8 and 88. 5 respectively, which was statistically significantly different （t = 12. 32, P 〈0. 01 ）. According to Brooker meth
出处
《中华关节外科杂志（电子版）》
CAS
2012年第6期42-45,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
关节成形术
置换
髋
感染
手术后并发症
Arthroplasty, replacement, hip
Infection
Postoperation complications
