Experience of using anterior windowing of the femur in revision total hip arthroplasty

目的 探讨在人工髋关节翻修术中采用股骨干前侧皮质开窗术取出股骨假体和髓腔内骨水泥的临床应用效果.方法 1999年9月至2011年5月共对31例人工髋关节翻修病例在术中采用前侧皮质开窗术.其中男性12例,女性19例；手术时年龄40 ～83岁,平均61.8岁.翻修原因包括:人工全髋关节置换术后假体松动12例、感染4例,股骨柄假体断裂11例,人工股骨头置换术后髋臼磨损4例.原股骨柄假体固定方式为骨水泥固定9例,生物型固定22例.股骨开窗均选择股骨干前侧皮质处,其中6例采用自股骨近端到假体远端的全长开窗,25例采用股骨柄远端处的局部开窗.4例感染病例取出原假体及骨水泥后行旷置术,另27例选择一期翻修术中股骨侧均选用生物周定的矩形加长柄.结果 所有病例术中均顺利取出原柄假体及骨水泥.术后12～18周,平均14周时复查X线片示开窗处骨愈合.1例术后出现复发性髋关节脱位,给予石膏短裤外固定8周.1例术后开窗远端内侧皮质骨纵行劈裂并髋关节脱位.再次翻修给予捆绑带固定.1例术后外伤致假体周围骨折行捆绑带固定治疗后痊愈.术后26例患者获得随访,随访时间0.5 ～12.0年,平均5.5年.Harris评分75 ～90分,平均83分.股骨假体固定良好无下沉,无松动.结论 股骨干前侧皮质开窗术应用于人工髋关节翻修术中,可以安全方便的取出原假体和髓腔内的骨水泥,防止发生术中骨折并发症,临床效果满意.Objective To discuss the clinical results of anterior windowing of the femur to remove the femoral component and cement in revision total hip arthroplasty.Methods From September 1999 to May 2011,31 revison cases received anterior windowing of the femur in operation.There were 12 male and 19 female,with the average age in operation was 61.8 years ( from 40 to 83 years ).The reason for revision included aseptic loosening in 12 cases,infection in 4 cases,breakage of femoral stem in 11 cases and acetabular liner wear in 4 hemi-arthroplasties.Nine cases were cemented and 22 were non-cemented for the primary stem.The position of the window located in the anterior femur with 6 cases of complete windowing from the proximal to the end of the stem.Another 25 cases received regional windowing just around the tip of the stem.In revisions,non-cemented rectangular revision stem were used for 27 cases and two-stage surgery were used for 4 infection cases.Results In all revisions,femoral stems and cement fragments were removed successfully and safely without any complicatins of fracture and perforation of new stems.All femur windows showed successfully union for average 14 weeks (12-18 weeks). There were some complications postoperational.One recurrent dislocation was treated using plaster external fixation for 8 weeks.One case with dislocation and fracture along with the window was revised by cerclage fixation. One periprosthetic fracture due to trauma was treated by cerclage fixation.The average Harris score of the hip improved to 83 points(75 to 90 points) at an average 5.5 years follow-up(0.5 to 12.0 years).Twenty six cases were completely followed up. Revison femoral stems were well-fixed without any subsidence or loosening.Conclusions Anterior windowing of the femur is a proven technique which can be used to remove femoral stem and cement conveniently and safely without any fratrues in revision total hip arthroplasty.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)05398-4015