CAJ | 학술논문

目的探讨生物型假体在人工髋关节翻修术中的应用方法和疗效.方法回顾性分析2004年1月至2009年12月行生物型假体人工髋关节翻修术的72例(72髋)患者资料.其中男性41例,女性31例；年龄28 ～ 82岁,平均65.7岁.包括髋关节感染2例,无菌性松动54例,假体周围骨折4例,假体柄断裂5例,人工股骨头置换后髋臼磨损7例.记录手术时间、出血量、截骨情况、植骨情况.观察术后感染、脱位、骨溶解、假体周围骨折、假体移位的发生情况.随访时髋关节功能评估采用Harris评分.结果手术时间70 ～ 280 min,平均(146±47) min;术中出血量200～2500 ml,平均( 970±540) ml.2例患者术中关节液培养提示细菌感染.7例行大粗隆近端截骨,4例行股骨远端开窗.术中股骨假体翻修时发生股骨近端骨折8例.术中共植骨29例.其中自体骨18例,异体骨11例.共67例患者获得随访,随访时间20～92个月,平均66个月.无死亡病例,无神经血管损伤,1例发生感染外院进行翻修,2例患者术后3个月内发生假体脱位行再次翻修手术.植骨部位愈合时间3～5个月.生物型股骨假体的存活率95.5％,生物型髋臼假体存活率为98.4％.Harris评分55～ 95分,平均(86±8)分.结论生物型假体在人工髋关节翻修术的应用中期疗效满意,术中的初期稳定性对于生物型假体的生存意义重大.
목적 탐토생물형가체재인공관관절번수술중적응용방법화료효.방법 회고성분석2004년1월지2009년12월행생물형가체인공관관절번수술적72례(72관)환자자료.기중남성41례,녀성31례；년령28 ～ 82세,평균65.7세.포괄관관절감염2례,무균성송동54례,가체주위골절4례,가체병단렬5례,인공고골두치환후관구마손7례.기록수술시간、출혈량、절골정황、식골정황.관찰술후감염、탈위、골용해、가체주위골절、가체이위적발생정황.수방시관관절공능평고채용Harris평분.결과 수술시간70 ～ 280 min,평균(146±47) min;술중출혈량200～2500 ml,평균( 970±540) ml.2례환자술중관절액배양제시세균감염.7례행대조륭근단절골,4례행고골원단개창.술중고골가체번수시발생고골근단골절8례.술중공식골29례.기중자체골18례,이체골11례.공67례환자획득수방,수방시간20～92개월,평균66개월.무사망병례,무신경혈관손상,1례발생감염외원진행번수,2례환자술후3개월내발생가체탈위행재차번수수술.식골부위유합시간3～5개월.생물형고골가체적존활솔95.5％,생물형관구가체존활솔위98.4％.Harris평분55～ 95분,평균(86±8)분.결론 생물형가체재인공관관절번수술적응용중기료효만의,술중적초기은정성대우생물형가체적생존의의중대.
Objective To assess the operative technique and results with the usage of cementless prothesis in hip revision.Methods Retrospective study was done on revision of total hip arthroplasty with cementless prothesis in 72 patients (41 males and 31 females) with an average age of 65.7 years (28-82 years) from January 2004 to December 2009. The reason for revision was 2 infection,54 aseptic lossening,4 periprosthetic fractures,5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty.The operation time,bleeding loss,comnplications of infection,dislocation,periprosthetic fractures and loosening were evaluated.The Harris score were used for hip function evaluation.Results The average operation time was ( 146 ± 47 )minutes( 70-280 minutes) and bleeding loss during the operation was ( 970 ± 540 ) ml ( 200-2500 ml ). Bacterium cultivation during operation demonstrated infection in 2 patients.Bone windows at the lateral femoral were opened in 4 patients and extend trochantcric osteotomy was done in 7 patients.Fracture of the proximal femur occurred in 8 cases.Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts.Sixty-seven patients were followed up for an average time of 66 months (20-92 months ). Additional revisions were performed in 3 cases including 2 dislocations and 1 infection.There were no death,no damage of major blood vessels and nerves.The bone graft healed during 3-5 months.The survival rates of the femoral prothesis and the acetabulum protheses were 95.5％ and 98.4％.The mean Harris score was 86 ± 8 (55-95 points).Osteolysis were seen in 13 hips but migration was seen in only 1 patient.Conclusions The cementless prothesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the relisble primary fixation.