半髋置换后全髋置换翻修的原因与结果△

Causes and outcomes of revision total hip arthroplasty for failed hemiarthroplasty

摘要:

[目的] 探讨半髋关节置换术 （hemiarthroplasty, HA） 后全髋关节置换术 （total hip arthroplasty, THA） 翻修的原因与临床疗效。[方法]回顾性分析本科 2010 年 1 月—2019 年 12 月对股骨颈骨折 HA 术后 THA 翻修的 39 例患者的临床资料，统计翻修的原因及临床和影像结果。[结果]39 例患者中，59.0%的患者存在臼底磨损，46.2%的患者存在股骨柄的问题。82.1%的患者更换了全套髋关节组件，17.9%的患者只更换了髋臼部分的组件。与翻修术前相比，末次随访时 39 例患者的屈髋 ROM 和 Harris 评分显著增加（P＜0.05），VAS 评分显著降低（P＜0.05），髋臼及股骨柄假体位置得到显著的改善（P＜0.05）。[结论] 髋臼磨损和股骨柄的松动是 HA 术后 THA 翻修术的主要原因，翻修后患者的关节功能仍可显著改善。

Abstract:

[Objective] To investigate the causes and clinical outcomes of revision total hip arthroplasty (THA) for failed hemiarthroplas- ty (HA) for femoral neck fractures. [Methods] A retrospective study was performed on 39 patients who underwent revision THA for failed HA for femoral neck fracture in our department from January 2010 to December 2019. The causes of revision, clinical and imaging results were analyzed statistically. [Results] Of the 39 patients, 59.0% had acetabular wear, while 46.2% had problems related to femoral stem. In addi- tion, 82.1% of patients had revision THA involving all components, while 17.9% had the acetabular component replaced only. Compared with those before revision, the hip extension-flexion range of motion (ROM) and Harris scores significantly increased (P＜0.05), whereas the VAS scores significantly decreased at the latest follow up (P＜0.05). Radiographically, the positions of acetabular and femoral components significantly improved after revision (P＜0.05). [Conclusion] Acetabular wear and femoral component loosening are the main causes of revi-sion THA for the failed HA, while the joint function does still be significantly improved after revision