本文選題：人工髖關(guān)節(jié) + 松動(dòng)　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景人工全髖關(guān)節(jié)置換術(shù)是治療髖關(guān)節(jié)疾病有效的方法之一,它的出現(xiàn)使得髖關(guān)節(jié)疾病給患者帶來(lái)的關(guān)節(jié)疼痛得到有效的緩解和消除,患者的髖關(guān)節(jié)功能和活動(dòng)度得到大幅提高,進(jìn)而使患者的生活質(zhì)量得到有效的改善。近年來(lái),一些術(shù)后并發(fā)癥的出現(xiàn),如假體無(wú)菌性松動(dòng)、感染,假體周圍骨折等,導(dǎo)致患者患肢出現(xiàn)不同程度的疼痛,關(guān)節(jié)活動(dòng)度受限,甚至肢體短縮畸形。這個(gè)時(shí)候就需要行髖關(guān)節(jié)翻修術(shù)來(lái)解決這些并發(fā)癥。目的通過回顧河南省人民醫(yī)院近5年來(lái)進(jìn)行的人工髖關(guān)節(jié)翻修手術(shù),對(duì)115例患者進(jìn)行臨床隨訪分析,探討人工髖關(guān)節(jié)翻修的原因和其短期的臨床療效。方法2009年03月～2014年10月我院共進(jìn)行了135例140髖人工髖關(guān)節(jié)翻修術(shù),其中115例115髖獲得了完整的隨訪資料,男60例,女55例,年齡27～86歲,平均66歲,左72髖,右43髖,初次置換距翻修術(shù)0.25～20年,平均8年。初次手術(shù)類型包括人工股骨頭置換11髖,全髖關(guān)節(jié)置換104髖。分析翻修患者初次髖關(guān)節(jié)置換術(shù)后行翻修術(shù)的原因,對(duì)患者術(shù)前及末次隨訪給予Harris及VAS評(píng)分及影像學(xué)檢查,對(duì)患者髖關(guān)節(jié)功能進(jìn)行評(píng)估,并對(duì)翻修近期效果做出評(píng)價(jià)。結(jié)果本組病例翻修原因：假體無(wú)菌性松動(dòng)61例(53%),術(shù)后感染22例(19%),假體周圍骨折20例(17%),脫位12例(11%)�；颊咝g(shù)后患髖疼痛癥狀均較術(shù)前改善,術(shù)后隨訪時(shí)間平均40個(gè)月(10～60個(gè)月),末次隨訪時(shí)本組患者VAS評(píng)分(1.10±0.892)分較術(shù)前(7.52±1.071)分顯著降低,Harris評(píng)分(85.30±6.728)分較術(shù)前(36.06±7.518)分顯著提高,其中優(yōu)40髖(90～100),良63髖(89～80),可8髖(79～70),差4髖(70),Harris優(yōu)良率89.57%,(P0.05),差異有統(tǒng)計(jì)學(xué)意義。本組患者術(shù)后無(wú)1例感染及脫位,假體松動(dòng)及下沉病例,末次隨訪時(shí)影像學(xué)結(jié)果顯示：植入假體位置良好,假體周圍未見透亮線及骨溶解。結(jié)論假體無(wú)菌性松動(dòng)是導(dǎo)致髖關(guān)節(jié)翻修的主要原因,其次是感染、假體周圍骨折和假體不穩(wěn)定導(dǎo)致的脫位；髖關(guān)節(jié)翻修可以有效的解決髖關(guān)節(jié)置換術(shù)后相關(guān)的并發(fā)癥,通過隨訪短期療效滿意,遠(yuǎn)期療效如何需要進(jìn)一步隨訪分析。
[Abstract]:Background Total hip replacement is one of the effective methods for the treatment of hip diseases. The hip function and range of motion of the patients were greatly improved, and the quality of life of the patients was improved effectively. In recent years, some postoperative complications, such as aseptic loosening of prosthesis, infection, periprosthetic fracture and so on, have led to pain in the affected limb, limited joint movement, and even limb shortening. At this point, hip revision is required to address these complications. Objective to investigate the causes and short-term clinical effects of artificial hip revision in 115 patients by reviewing the revision operation of artificial hip in Henan Provincial people's Hospital in recent 5 years. Methods from March 2009 to October 2014, a total of 135 cases (140 hips) underwent revision of the artificial hip joint in our hospital. 115 cases (60 males and 55 females) were followed up. The average age was 2786 years (mean 66 years), left 72 hips and right 43 hips. The first replacement distance was 0.25 ~ 20 years (mean 8 years). The primary types of operation included artificial femoral head replacement (11 hips) and total hip arthroplasty (104 hips). The causes of revision after primary hip arthroplasty were analyzed. Harris and VAS scores and imaging examination were given to the patients before and after the last follow-up. The function of the hip joint was evaluated and the short-term effect of the revision was evaluated. Results the causes of revision were aseptic loosening in 61 cases, postoperative infection in 22 cases, periprosthetic fracture in 20 cases and dislocation in 12 cases. The postoperative hip pain symptoms were improved after operation. The average follow-up time was 40 months to 60 months. At the last follow-up, the scores of VAS score (1.10 鹵0.892) were significantly lower than those before operation (7.52 鹵1.071), and the scores of VAS score (85.30 鹵6.728) were significantly higher than those of preoperative patients (36.06 鹵7.518). The excellent and good rate of Harris was 89.57% (P 0.05) in 40 hips of excellent quality (40 hips), the good rate of good 63 hips (89 ), the fair rate of 8 hips (79%) 70%, and the poor rate of 4 hips (4 hips) with P 0.05% (P 0.05). There was no infection, dislocation, loosening and sinking of the prosthesis after operation. The imaging results of the last follow-up showed that the implanted prosthesis was in a good position with no clear lines and osteolysis around the prosthesis. Conclusion prosthetic aseptic loosening is the main cause of hip revision, followed by infection, periprosthetic fracture and dislocation caused by prosthesis instability. After a short-term follow-up, the long-term results need to be further followed up analysis.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 劉寧;查振剛;姚平;林宏生;王國(guó)普;吳昊;王雙利;;骨移植在人工髖關(guān)節(jié)股骨側(cè)假體翻修中應(yīng)用[J];南方醫(yī)科大學(xué)學(xué)報(bào);2007年09期

2 王永勝;喬治;張弛;王秀利;王義生;;人工髖關(guān)節(jié)翻修術(shù)臨床療效48例觀察[J];河南醫(yī)學(xué)研究;2014年02期

3 寇伯龍,林劍浩,關(guān)振鵬,孫鐵錚,魏威,李虎,呂厚山;非骨水泥型髖假體進(jìn)行髖關(guān)節(jié)翻修的四年隨訪研究[J];中華外科雜志;2005年08期

4 馬建兵;劉淼;孟祥東;姚建鋒;;聚乙烯微粒細(xì)胞因子與人工髖關(guān)節(jié)松動(dòng)的相關(guān)性研究[J];中國(guó)矯形外科雜志;2009年09期

相關(guān)碩士學(xué)位論文 前2條

1 李賽帥;組配式生物股骨柄在髖關(guān)節(jié)翻修中的應(yīng)用[D];中南大學(xué);2010年

2 郭通亞;人工全髖關(guān)節(jié)翻修旋轉(zhuǎn)中心重建療效隨訪的初步報(bào)告[D];蚌埠醫(yī)學(xué)院;2013年

，

本文編號(hào)：1914798