CAJ | 학술논문

　　目的观察体外冲击波对人工髋关节置换翻修骨水泥股骨假体取出的影响。方法患者入选标准：年龄45～79岁，翻修距初次手术时间5～20年；无菌性骨水泥假体松动；单侧翻修；初次手术用国产假体及骨水泥；自愿参加本研究并签署知情同意书。将符合入选标准的32例患者按简单数字随机法分为干预组和对照组，每组16例，干预组术前5天开始，每日1次(2000次脉冲)，每次30 min，共5次(10000次脉冲)的体外冲击波治疗，对照组术前不行体外冲击波治疗。由同一人按完整拔除标准(一次性完全拔除)、开骨取出标准(无法拔除或仅部分拔除)、耗时计算标准(自开始取时始至全部取出时止)、出血量计算标准(自切皮始至缝皮止)分别统计两组患者数据，并从疼痛、功能、关节活动度、关节畸形4个方面行术前1周及术后1个月 Harris 评分。结果干预组假体完整拔出者(16例中8例，50.00%)较对照组(16例中2例，12.50%)多( P＜0.05)，非完整拔除者干预组开骨者(8例中2例，25.00%)较对照组(14例中10例，71.43%)少( P＜0.05)；干预组取出植入物耗时(310.1±129.5) s 较对照组(978.9±110.2) s 短( P＜0.01)；干预组术中出血量(610.9±126.5) ml 较对照组(1110.1±140.4) ml 少( P＜0.01)。Harris 评分术前1周干预组(69.1±4.5)与对照组(70.2±5.2)差异无统计学意义( P＞0.05)；术后1个月干预组(94.1±3.5)较对照组(90.9±4.2)高( P＜0.05)。结论体外冲击波利于人工髋关节置换翻修骨水泥股骨假体取出。
　　목적관찰체외충격파대인공관관절치환번수골수니고골가체취출적영향。방법환자입선표준：년령45～79세，번수거초차수술시간5～20년；무균성골수니가체송동；단측번수；초차수술용국산가체급골수니；자원삼가본연구병첨서지정동의서。장부합입선표준적32례환자안간단수자수궤법분위간예조화대조조，매조16례，간예조술전5천개시，매일1차(2000차맥충)，매차30 min，공5차(10000차맥충)적체외충격파치료，대조조술전불행체외충격파치료。유동일인안완정발제표준(일차성완전발제)、개골취출표준(무법발제혹부부분발제)、모시계산표준(자개시취시시지전부취출시지)、출혈량계산표준(자절피시지봉피지)분별통계량조환자수거，병종동통、공능、관절활동도、관절기형4개방면행술전1주급술후1개월 Harris 평분。결과간예조가체완정발출자(16례중8례，50.00%)교대조조(16례중2례，12.50%)다( P＜0.05)，비완정발제자간예조개골자(8례중2례，25.00%)교대조조(14례중10례，71.43%)소( P＜0.05)；간예조취출식입물모시(310.1±129.5) s 교대조조(978.9±110.2) s 단( P＜0.01)；간예조술중출혈량(610.9±126.5) ml 교대조조(1110.1±140.4) ml 소( P＜0.01)。Harris 평분술전1주간예조(69.1±4.5)여대조조(70.2±5.2)차이무통계학의의( P＞0.05)；술후1개월간예조(94.1±3.5)교대조조(90.9±4.2)고( P＜0.05)。결론체외충격파리우인공관관절치환번수골수니고골가체취출。
Objective To investigate the effects of extracorporeal shock wave ( ESW ) to the removal of cemented femoral prostheses in the revision of artificial hip replacement ( AHR ). Methods The inclusion criteria were stated as following: patients ( 45-79 years old ) underwent revision 5 to 20 years after the initial operation;aseptic loosening of cemented femoral prostheses;unilateral revision and domestic prostheses and bone cements in the initial operation;volunteered to participate in this study and sign informed consents. According to the single or dual number of admission sequence, a total of 32 patients meeting the inclusion criteria were randomly divided into 2 groups:the intervention group ( n=16 ), who were treated with preoperative ESW therapy once a day for 5 days and 30 minutes each time, amounting to 5 times with 10 000 pulses in all, and the control group ( n=16 ), who were not treated with preoperative ESW therapy. The same person was in charge of recording the statistical data of the 2 groups according to the 4 standards, including complete removal ( disposable removal ), cutting femurs and removing the implants ( impossible to eradicate or only partially removed ), time-consuming calculation ( from the beginning of the removal until all the femoral implants were removed ) and bleeding volume calculation ( from skin incision to skin suture ). Furthermore, the Harris score was used to evaluate the 4 aspects 1 week before the surgery and 1 month after the surgery, including pain, function, range of motion and joint deformity. Results The cases that the implants were completely removed in the intervention group ( 8 out of 16 cases, 50.00%) were more than that in the control group ( 2 out of 16 cases, 12.50%) ( P<0.05 ). On the other hand, compared with that in the control group ( 10 out of 14 cases, 71.43%), the cases that the femurs were cut and the implants were not completely removed were less in the intervention group ( 2 out of 8 cases, 25.00%) ( P<0.05 ). Meanwhile, less time was needed in the intervention group ( 310.1±129.5 s ) than that in the control group ( 978.9±110.2 s ) for the removal of the implants ( P<0.01 ), and there was less amount of bleeding in the intervention group ( 610.9±126.5 ml ) than that in the control group ( 1110.1±140.4 ml ) ( P<0.01 ). There were no significant differences ( P>0.05 ) in the Harris score 1 week before the surgery between the intervention group ( 69.1±4.5 points ) and the control group ( 70.2±5.2 points ), but the Harris score 1 month after the surgery was higher in the intervention group ( 94.1±3.5 points ) than that in the control group ( 90.9±4.2 points ) ( P<0.05 ). Conclusions In the revision surgery of AHR, ESW is helpful in removing the cemented femoral prostheses.