CAJ | 학술논문

目的：探讨生物型翻修加长柄治疗全髋关节置换（THA）术后股骨假体松动伴股骨骨缺损的早中期疗效。方法对21例（21髋）自2009年1月至2014年3月在广西医科大学第四附属医院关节骨病科因THA术后股骨假体松动伴股骨骨缺损的患者采用生物型翻修加长柄治疗。股骨缺损病例中的3例未予植骨，17例采用自体或同种异体颗粒骨植骨，1例自体大块髂骨结构性植骨，使用钢丝、钢缆固定。结果术后髋关节疼痛消失或明显缓解，关节功能改善。21例获随访8～55个月，平均42个月，未发现感染病例。末次随访时未发现假体周围骨折及假体远端出现新透亮带。Harris评分：术前32～38分，平均（34．9±1．8）分；术后71～89分，平均（84．8±4．0）分，手术前后Harris评分比较有统计学差异（P＜0．05）。术后髋关节功能较术前明显得到改善。结论人工全髋关节翻修术中使用生物型翻修加长柄治疗股骨假体松动伴股骨骨缺损患者的早中期疗效可靠，但远期疗效有待进一步随访观察。
목적：탐토생물형번수가장병치료전관관절치환（THA）술후고골가체송동반고골골결손적조중기료효。방법대21례（21관）자2009년1월지2014년3월재엄서의과대학제사부속의원관절골병과인THA술후고골가체송동반고골골결손적환자채용생물형번수가장병치료。고골결손병례중적3례미여식골，17례채용자체혹동충이체과립골식골，1례자체대괴가골결구성식골，사용강사、강람고정。결과술후관관절동통소실혹명현완해，관절공능개선。21례획수방8～55개월，평균42개월，미발현감염병례。말차수방시미발현가체주위골절급가체원단출현신투량대。Harris평분：술전32～38분，평균（34．9±1．8）분；술후71～89분，평균（84．8±4．0）분，수술전후Harris평분비교유통계학차이（P＜0．05）。술후관관절공능교술전명현득도개선。결론인공전관관절번수술중사용생물형번수가장병치료고골가체송동반고골골결손환자적조중기료효가고，단원기료효유대진일보수방관찰。
Objective To investigate the earlyandmid-termeffects of the cementlesslong-stem revision for prosthesis loosening with femoral bone defect following total hip arthroplasty. Methods Twenty-one patients ( 21 hips ) of femoral prosthesis loosening with femoral bone defect after total hip arthroplasty in orthopedic department, the 4th Affiliated Hospital of Guangxi Medical University, were treated by the cementless long-stem revision.Three cases did not use bone grafting, 17 cases adopted autologous or allogeneic morselized bone grafting, and one case accepted structural autologous iliac bone grafting.All the patients underwent internal fixation with wires and cables.Results The hip pain disappeared or was relieved obviously after the surgery, and the joint functions were improved.All the cases were followed up for eight to 55 months, 42 months in average.No infection, periprosthetic fractures, or new radiolucent zone at the distal part of the prosthesis was observed at the latest follow-up. The preoperative Harris score was 32-38, (34.9 ±1.8) in average, and the postoperative Harris score was 71-89, ( 84.8 ±4.0 ) in average.The preoperative Harris score of the patients was statistically significant ( P<0.05) , and the postoperative hip function was significantly improved compared with the preoperative one.Conclusion The total hip arthroplasty revision using cementless long-stem prosthesis for the treatment of femoral prosthesis loosening with femoral bone defects shows reliable early and mid-term curative effects , but the long-term effect needs further follow-up observation.