CAJ | 학술논문

目的探讨初次髋关节置换术后早期翻修的原因和防治方法.方法回顾性分析2002年1月至2007年6月55例行人工髋关节翻修术患者的资料,其中术后5年内(含5年)翻修11例,翻修原因及翻修方式为:髋臼假体位置不良导致复发性脱位2例,手术调整髋臼假体位置;髋臼假体松动5例,翻修髋臼和(或)股骨假体;术后早期股骨假体周围骨折2例,行骨折复位固定;股骨头磨损髋臼1例,行全髋翻修;感染1例,行二期手术翻修.术前和术后随访采用Harris评分评估髋关节功能.术前Harris评分平均46分(28～62分).结果本组随访时间16～76个月,平均36个月.术后Harris评分提高至平均86分(75～96分).术后出现并发症2例:1例术后局部血肿形成,4周后需再次手术清理血肿;1例术后关节不稳,经适当牵引制动后关节不稳定现象消失.无感染、深静脉血栓、主要血管和神经损伤等并发症发生.结论初次髋关节置换早期翻修主要原因与髋臼假体处理、假体选择和安放技术不当有关,因此提高髋臼假体安放的手术技术有助于改善人工髋关节的疗效.
목적 탐토초차관관절치환술후조기번수적원인화방치방법.방법 회고성분석2002년1월지2007년6월55례행인공관관절번수술환자적자료,기중술후5년내(함5년)번수11례,번수원인급번수방식위:관구가체위치불량도치복발성탈위2례,수술조정관구가체위치;관구가체송동5례,번수관구화(혹)고골가체;술후조기고골가체주위골절2례,행골절복위고정;고골두마손관구1례,행전관번수;감염1례,행이기수술번수.술전화술후수방채용Harris평분평고관관절공능.술전Harris평분평균46분(28～62분).결과 본조수방시간16～76개월,평균36개월.술후Harris평분제고지평균86분(75～96분).술후출현병발증2례:1례술후국부혈종형성,4주후수재차수술청리혈종;1례술후관절불은,경괄당견인제동후관절불은정현상소실.무감염、심정맥혈전、주요혈관화신경손상등병발증발생.결론 초차관관절치환조기번수주요원인여관구가체처리、가체선택화안방기술불당유관,인차제고관구가체안방적수술기술유조우개선인공관관절적료효.
Objectives To analyze the reason of revisions no more than S years after primary hip replacement,and to discuss the methods how to prevent and manage. Methods Retrospectively review 11 cases with revision no more than 5 years after primary total hip replacement from January 2002 to June 2007. The reasons for revision were as follows: 2 cases were recurrent dislocation due to malposition of acetabular prosthesis; 5 cases were loosening of acetabular prosthesis; 1 case was abrasion of the native acetabulum by bipolar femoral head; 2 cases were periprosthetic femoral fractures and 1 case was periprosthetic infection. The average follow-up time was 36 months. Each patient was assessed according to Harris hip score. The revision procedures including liner only, acetabular prosthesis only, or both acetabular prosthesis and femoral prosthesis depending on the reasons for revision, two-stage revision was performed on 1 case with periprosthetic infection. Results The average of Harris hip score was increased from 46 (28 to 62 ) preoperatively to 86(75 to 96) at follow up. The complication occurred in 2 cases; one was postoperative haematoma formation who was performed further surgery for clearance of haematoma, another was slight instability of the hip joint who was accepted skin traction for 3 weeks. Conclusions The main reason for revision after primary total hip replacement is related to uncorrected insert of acetabular prosthesis. Improving surgical technique of insert of acetabular prosthesis is important in primary total hip replacement.