糖尿病患者行髋关节置换73例

背景：糖尿病患者并发关节疾患逐渐增多，但糖尿病患者行人工关节置换的报道较少。 目的：分析糖尿病患者行人工髋关节置换的效果。 方法：共收治572例行初次全髋关节置换治疗患者，从中筛选出2型糖尿病患者73例(80髋)，男50例，女23例，年龄49~81岁，平均(62.6±5.4)岁。55例患者入院前经饮食和口服降糖药物控制血糖，18例患者经胰岛素控制血糖。57例62髋用生物固定型髋关节假体，16例18髋用骨水泥固定髋关节假体。 结果与结论：置换前Harris评分平均为55.4分，置换后为84.2分，优良率96.5%。随访3个月~9年后Harris评分平均为77.6分，优良率为80.2%。52例患者复查X射线片，均未发现迟发感染，未发现假体明显松动。复查X射线片与出院时X射片对照，40例假体位置未改变，髋关节间隙无狭窄，11例假体轻度下沉(平均下沉为2 mm)，7例有轻微髋关节疼痛。另外有5例出现髋臼缘骨质增生。全部患者未行假体翻修。作者认为，糖尿病患者如无严重并发症，经过周密正确的围手术期处理和良好的血糖控制等内科治疗后接受人工关节置换，可获得良好的疗效。

Clinical efficacy analysis and experience in 73 cases of diabetics undergoing hip joint replacement

BACKGROUND: With the growth in the incidence of diabetes, the number of diabetic patients accompanied with joint disease is increasing, but diabetic patients undergoing hip joint replacement are rarely reported. OBJECTIVE: To analyze the clinical effect of diabetic patients undergoing hip joint replacement and to sum up the experience. METHODS: Seventy-three diabetic patients (80 hips) received arthroplasty, including 50 males and 23 females, aged 49-81 years, averagely (62.6±5.4) years. Fifty-five patients were treated by diet and oral antidiabetic drugs before admission, and 18 by the insulin. Of the 73 patients, 57 cases (62 hips) underwent biomedical hip prosthesis, and 16 (18 hips) received bone cement + hip prosthesis. RESULTS AND CONCLUSION: Harris score was increased from preoperative 55.4 points to 84.2 points, and the good rate good was 96.5%. After a mean 4.5 years follow-up (ranging 3 months-9 years), the mean Harris score was 77.6 points and the good rate was 80.2%. No delayed infection and prosthesis loosening occurred after operation. The prostheses of 40 cases had no changes, and the prostheses had a slight sinking in 11 cases (average sinking to 2 mm), 7 patients had mild hip pain, and 5 cases presented with acetabular rim hyperostosis. Prosthesis renovation was not performed in all the cases. The author thought that diabetics without serious complications, by proper perioperative management, good blood glucose control and so on, can obtain a good effect on hip arthroplasty.