CAJ | 학술논문

背景：在髋关节翻修过程中移除固定良好的生物型假体柄及骨水泥柄很困难，应用大转子延长截骨能很好的解决这个问题，结合生物型加长柄能降低翻修后并发症。 　　目的：回顾性分析大转子延长截骨结合生物型加长柄翻修人工髋关节的近期效果。 　　方法：选择2008年5月至2013年5月于平顶山市第一人民医院关节骨病科进行人工髋关节翻修的25例患者，其中17例应用单切口双入路行大转子延长截骨，术中股骨重建均采用生物型翻修加长柄。随访12-60个月，记录翻修前后Harris髋关节评分、翻修后并发症，记录截骨长度、假体柄在股骨髓腔内远端固定的长度和截骨处远端至假体末端的长度。 　　结果与结论：17例患者均获随访，平均截骨长度17 cm(15-23 cm)，平均假体柄和髓腔接触面长度为6.4 cm (4-11 cm)，截骨处远端至假体末端的平均长度为11.5 cm(8-18.5 cm)。至随访结束，患者髋关节Hariss评分从治疗前(39.0±13.6)分提高到治疗后(75.0±14.9)分，差异有显著性意义(P<0.01)。2例患者发生假体柄下沉，17例患者大转子延长截骨处均固定良好。提示大转子延长截骨结合生物型加长柄翻修人工髋关节过程中，单切口双入路法松解髋关节周围瘢痕并使髋关节前脱位能保护后关节囊和外旋肌，加强髋关节后侧稳定性，减少翻修后脱位率，近期效果满意，长期效果还需进一步观察。
배경：재관관절번수과정중이제고정량호적생물형가체병급골수니병흔곤난，응용대전자연장절골능흔호적해결저개문제，결합생물형가장병능강저번수후병발증。 　　목적：회고성분석대전자연장절골결합생물형가장병번수인공관관절적근기효과。 　　방법：선택2008년5월지2013년5월우평정산시제일인민의원관절골병과진행인공관관절번수적25례환자，기중17례응용단절구쌍입로행대전자연장절골，술중고골중건균채용생물형번수가장병。수방12-60개월，기록번수전후Harris관관절평분、번수후병발증，기록절골장도、가체병재고골수강내원단고정적장도화절골처원단지가체말단적장도。 　　결과여결론：17례환자균획수방，평균절골장도17 cm(15-23 cm)，평균가체병화수강접촉면장도위6.4 cm (4-11 cm)，절골처원단지가체말단적평균장도위11.5 cm(8-18.5 cm)。지수방결속，환자관관절Hariss평분종치료전(39.0±13.6)분제고도치료후(75.0±14.9)분，차이유현저성의의(P<0.01)。2례환자발생가체병하침，17례환자대전자연장절골처균고정량호。제시대전자연장절골결합생물형가장병번수인공관관절과정중，단절구쌍입로법송해관관절주위반흔병사관관절전탈위능보호후관절낭화외선기，가강관관절후측은정성，감소번수후탈위솔，근기효과만의，장기효과환수진일보관찰。
BACKGROUND:Extraction of a wel fixed cementless femoral stem or a cemented stem is difficult during revision of total hip arthroplasty. The extended trochanteric osteotomy provides excellent methods, and combining with long-stem cementless prosthesis can better reduce postoperative complications. OBJECTIVE:To retrospectively analyze the recent clinical curative effect after extended trochanteric osteotomy combined with long-stem cementless prosthesis in hip revision. METHODA total of 25 patients undergoing hip revision were selected from the Department of Osteoarthrosis, Pingdingshan First People’s Hospital, China from May 2008 to May 2013. Of them, 17 patients were subjected to the extended trochanteric osteotomy combined with single-incision and double-approaches. The femurs were reconstructed with long-stem cementless prosthesis. Al patients were fol owed-up for 12 to 60 months. Pre-operative and post-operative Harris hip scores, the post-operative complications, the bone cutting length, the length of stem in contact with cortical bone, the length of the end of bone cutting to the end of the prosthesis were recorded. RESULTS AND CONCLUSION:17 patients were fol owed-up. The mean length of bone was 17 cm (15-23 cm). The mean length of stem in contact with cortical bone was 6.4 cm (4-11 cm). The mean length of the end of bone to the end of the prosthesis was 11.5 cm (8-18.5 cm). After fol ow-up, the mean Harris hip scores were improved from (39.0 ± 13.6) scores preoperatively to (75.0 ± 14.9) scores postoperatively (P<0.01). Subsidence occurred in two hips. The cutting sites of 17 cases of extended trochanteric osteotomy were fixed wel . These data suggested that the operation through single-incision and double-approach to the hip, while preserving the attachment of the external rotators and posterior capsule, wil strength rear hip stability and prevent postoperative dislocations. Recent effects were satisfactory, but the long-term outcomes should be further investigated.