最常见并发症是下肢深静脉血栓形成.doc

最常见并发症是下肢深静脉血栓形成
•最严重的并发症是感染
•最重要的长期并发症是关节松动及磨损

1.深静脉血栓形成 Deep Venous Thrombosis (DVT)
•最常见并发症most common complication
–血栓停留在下肢问题并不太严重As long as the clots remain in the legs they are a relatively minor problem.
–如果血栓脱落经心脏栓塞肺动脉可导致死亡Occasionally they dislodge and travel through the heart to the lungs (pulmonary embolism). death can result from embolism.
–肺栓塞发生率为数百分之一The chances of PE are one out of several hundred.

•鼓励患者尽早活动Encouraging activity as soon as possible
•压力袜子促进血液流动Pressure stockings to keep the blood in the legs moving
•药物应用防止血栓Medications that thin the blood and prevent blood clots from forming

2. 感染Infection
•初次关节置换感染率1%，翻修手术感染率3% About 1% for first OP,for revision 3%
•预防Prevention
–层流手术室laminar flow operating room
–抗菌素合理应用Antibiotics
–缩短手术时间Shorten operation time…
–好的经验Good experience
•感染高发因素High infection rate
–类风湿性关节炎或糖尿病rheumatoid arthritis or diabetes
–长时间应用激素taking cortisone for prolonged periods of time,
–既往关节感染病史joint has had previous infection
– 手术时身体其他部位感染（牙齿、膀胱等）have infection anywhere else (teeth, bladder, etc.) at the time of surgery.

3.假体松动 Loosening of the prosthesis
•取决于Dependent on
–手术好坏How well the surgery is done
–骨的质量The quality of bones
–活动情况How active
–体重Weight
–假体是否应用骨水泥，目前认为非骨水泥假体使用时间长于骨水泥假体Whether or not the implant is cemented :At present it is believed that uncemented implants will last longer than cemented ones
–假体设计The design of the implant

4. 聚乙烯臼衬磨损Wear of the Plastic Polyethylene Socket
•about 0.1 millimeters per year
•more rapid in very active patients
•“Cross-linked” polyethylene（高交链聚乙烯HXLPE） promises a wear rate about half that of PE(普通聚乙烯)
•Plastic -- ceramic ball is much less wear
•Metal-on-metal bearings will never wear out.
•Nor will ceramic-on-ceramic implants , but there is a 1/20,000 risk of fracture of the ceramic ball.

5.关节脱位 Dislocation of the hip replacement
•more likely to dislocate in the first 6 weeks
•About 2%

Prevention of dislocation
•Do not cross legs
•Do not flex legs up beyond 90 degrees
•Do not sit on sofas or in low chairs
•Do not sleep on affected side

6.异位骨化 Ectopic bone formation
•causes the hip to be stiffer than desired

7.股骨骨折 Fracture of the femur
•more common during revision hip surgery
•Complete fracture may require separate surgery for fixation. Small cracks may need to be treated with wires.

8. 残余疼痛及关节僵硬Residual pain and stiffness
•Some patients have pain after surgery which cannot be explained
•Some patients with un-cemented hip replacements develop mid thigh pain.
• The pain is usually mild, and almost always resolves after 18 to 24 months.
• It has been found that the larger the diameter if the implant installed the more likely “thigh pain” will develop.
• For this reason, Dr. Huddleston almost never installs an un-cemented femur implant larger than 17 millimeters in diameter.

9.术后下肢不等长 Alteration of Limb Length Postoperatively

10. 下肢血管神经损伤Injury to the arteries or nerves of the leg
•exceedingly rare
•sciatic nerve injury 0.2%

11. 出血并发症Bleeding complications.
•hematoma formation.
•It may distend the hip and cause dislocation.
•If it is excessive, it may require re-opening the wound under anesthesia to let the blood out.

12. 麻醉并发症Anesthetic complications
• very rarely even death can occur from the anesthesia.

13. 输血并发症Complications From Blood Transfusions
•AIDS 1:2000000
•Hepatitis B 1:550
•Hepatitis C 1:100
•allergic reaction 1:500
•Hemolytic Transfusion Reaction is 1 in 10,000

14. 脂肪栓塞Fat Embolism
•Fat from the bone marrow can get into the circulation and cause lung or neurological symptoms.
•This is a very rare complication.
• In very rare cases it can be fatal

15. 其它轻微并发症Other minor complications
•allergies to medications
•Allergy to the metal parts
•Infection in lung ，urine tract
•Bed sore

•There are risks in everything we do in life