膝关节置换术后翻修的主要原因分析
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摘要
目的探讨膝关节置换术后翻修手术的主要原因。方法回顾2010年1月至2017年6月在北京积水潭医院接受膝关节置换术后翻修手术的158例病历资料。通过分析病历记录、实验室检查、影像学检查和手术记录,确定膝关节翻修原因。初次膝关节置换术后2年内进行的翻修为早期翻修,2年后进行的翻修为晚期翻修。结果膝关节置换术后翻修的常见原因有:假体周围感染(41. 6%)、假体松动(24. 8%)和不稳定(9. 9%)。聚乙烯磨损(3. 1%)不是膝关节翻修的主要原因。早期翻修的常见原因是假体周围感染(61. 1%)、僵直(12. 5%)和不稳定(8. 3%),晚期翻修的常见原因是假体松动(41. 6%)、假体周围感染(25. 8%)和不稳定(11. 2%)。结论膝关节翻修的主要原因是假体周围感染。最常见的早期翻修原因是假体周围感染,而最常见的晚期翻修原因是假体松动。应该重视围手术期感染的预防和假体周围感染的防治。
Objective To investigate the main factors affecting revision of total knee arthroplasty.Methods A total of 158 cases of revision of total knee arthroplasties were included in Beijing Jishuitan Hospital from January 2010 to June 2017. Clinical records,laboratory tests,radiographic studies and intraoperative findings were used to investigate the factors affecting the revision. The early failure was defined as revision performed within 2 years after the primary total knee arthroplasty,and the late failure was defined as revision performed after 2 years after the primary total knee arthroplasty. Results The common causes for revision of total knee arthroplasty were infection( 41. 6%),aseptic loosening( 24. 8%) and instability( 9. 9%).Polyethylene wear( 3. 1%) was no longer the major cause of failure. The common causes of early failure were infection( 61. 1%),stiffness( 12. 5%),and instability( 8. 3%),while that of late failure were aseptic loosening( 41. 6%),infection( 25. 8%),and instability( 11. 2%). Conclusion The main cause for revision of total knee arthroplasty is infection. Infection is the main reason for early revision,and aseptic loosening is the main reason for late revision. Efforts of orthopedic surgeons should focus on infection prophylaxis,diagnosis and treatment.
Objective To investigate the main factors affecting revision of total knee arthroplasty.Methods A total of 158 cases of revision of total knee arthroplasties were included in Beijing Jishuitan Hospital from January 2010 to June 2017. Clinical records,laboratory tests,radiographic studies and intraoperative findings were used to investigate the factors affecting the revision. The early failure was defined as revision performed within 2 years after the primary total knee arthroplasty,and the late failure was defined as revision performed after 2 years after the primary total knee arthroplasty. Results The common causes for revision of total knee arthroplasty were infection( 41. 6%),aseptic loosening( 24. 8%) and instability( 9. 9%).Polyethylene wear( 3. 1%) was no longer the major cause of failure. The common causes of early failure were infection( 61. 1%),stiffness( 12. 5%),and instability( 8. 3%),while that of late failure were aseptic loosening( 41. 6%),infection( 25. 8%),and instability( 11. 2%). Conclusion The main cause for revision of total knee arthroplasty is infection. Infection is the main reason for early revision,and aseptic loosening is the main reason for late revision. Efforts of orthopedic surgeons should focus on infection prophylaxis,diagnosis and treatment.
引文
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[9]冯宾,翁习生,林进,等.初次全膝关节置换术后并发症及翻修手术的原因分析[J].中华外科杂志,2015,53(2):106-109.DOI:10.3760/cma.j.issn.0529-5815.2015.02.006.
[10]黄自强,孙长鲛.膝关节置换患者手术失败原因的分析[J].中华医学杂志,2015,95(20):1606-1608.DOI:10.3760/cma.j.issn.0376-2491.2015.20.014.
[11]Sharkey PF,Hozack WJ,Rothman RH,et al.Insall award paper.Why are total knee arthroplasties failing today?[J].Clin Orthop Relat Res,2002(404):7-13.DOI:10.1097/01.blo.0000036002.13841.32.
[12]Brown TS,Van Citters DW,Berry DJ,et al.The use of highly crosslinked polyethylene in total knee arthroplasty[J].Bone Joint J,2017,99-B(8):996-1002.DOI:10.1302/0301-620X.99B8.BJJ-2017-0028.R1.
[13]Feng EL,Stulberg SD,Wixson RL.Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces[J].Clin Orthop Relat Res,1994(299):60-71.PMID:8119038.
[2]Delanois RE,Mistry JB,Gwam CU,et al.Current epidemiology of revisiontotal knee arthroplasty in the United States[J].J Arthroplasty,2017,32(9):2663-2668.DOI:10.1016/j.arth.2017.03.066.
[3]Kurtz S,Ong K,Lau E,et al.Projections of primary and revisionhip and knee arthroplasty in the United States from 2005 to 2030[J].J Bone Joint Surg Am,2007,89(4):780-785.DOI:10.2106/JB-JS.F.00222.
[4]Moreland JR.Mechanisms of failure in total knee arthroplasty[J].Clin Orthop Relat Res,1988(226):49-64.PMID:3335107.
[5]Vince KG.The problem total knee replacement:systematic,comprehensive and efficient evaluation[J].Bone Joint J,2014,96-B(11Supple A):105-111.DOI:10.1302/0301-620X.96B11.34531.
[6]Healy WL,Della Valle CJ,Iorio R,et al.Complications of total knee arthroplasty:standardized list and definitions of the Knee Society[J].Clin Orthop Relat Res,2013,471(1):215-220.DOI:10.1007/s11999-012-2489-y.
[7]Sharkey PF,Lichstein PM,Shen C,et al.Why are total knee arthroplasties failing today--has anything changed after 10 years?[J].J Arthroplasty,2014,29(9):1774-1778.DOI:10.1016/j.arth.2013.07.024.
[8]Khan M,Osman K,Green G,et al.The epidemiology of failure in total knee arthroplasty:avoiding your next revision[J].Bone Joint J,2016,98-B(1 Suppl A):105-112.DOI:10.1302/0301-620X.98B1.36293.
[9]冯宾,翁习生,林进,等.初次全膝关节置换术后并发症及翻修手术的原因分析[J].中华外科杂志,2015,53(2):106-109.DOI:10.3760/cma.j.issn.0529-5815.2015.02.006.
[10]黄自强,孙长鲛.膝关节置换患者手术失败原因的分析[J].中华医学杂志,2015,95(20):1606-1608.DOI:10.3760/cma.j.issn.0376-2491.2015.20.014.
[11]Sharkey PF,Hozack WJ,Rothman RH,et al.Insall award paper.Why are total knee arthroplasties failing today?[J].Clin Orthop Relat Res,2002(404):7-13.DOI:10.1097/01.blo.0000036002.13841.32.
[12]Brown TS,Van Citters DW,Berry DJ,et al.The use of highly crosslinked polyethylene in total knee arthroplasty[J].Bone Joint J,2017,99-B(8):996-1002.DOI:10.1302/0301-620X.99B8.BJJ-2017-0028.R1.
[13]Feng EL,Stulberg SD,Wixson RL.Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces[J].Clin Orthop Relat Res,1994(299):60-71.PMID:8119038.