什么情况下需要置换髋关节？ 髋关节置换的医患须知

（自主翻译及整理而来）

Total Hip Replacement  （1）

全髋关节置换（中英对照）

Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.广东省中医院骨科许树柴

无论你是刚开始寻找治疗方案，或已经决定接受髋关节置换手术，本文将帮助您了解全髋关节置换术的优点和局限性。本文介绍了一个正常的髋关节在人体的作用、导致髋关节疼痛的原因、对于髋关节置换手术我们可以有什么期望以及什么样的练习和活动将助于恢复患者身体的活动性与力量，让患者回归社会活动。

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting

如果你的髋关节因关节炎、骨折或其它原因而被破坏，诸如散步或起坐椅子等日常生活都可能导致疼痛和难以完成。你的髋关节僵硬，可能让你连你的鞋子、袜子拿起来都难。你甚至在休息的时候都会感觉到不舒服。.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

如果药物治疗、生活习惯的改变以及一些辅助步行的工具不能充分地帮助你缓解症状，您可以考虑髋关节置换手术。髋关节置换手术是一种安全而有效的方法，它可以减轻你的痛苦，改善肢体活动，帮你重新享受正常的日常活动

First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 285,000 total hip replacements are performed each year in the United States.

最早实践于1960年，髋关节置换手术是在当时医学上最成功的成就之一。自1960年以来，在关节置换手术的手法和技术的改进大大提高了全髋关节置换成效。据卫生保健研究质量局报道，在美国，每年有超过285,000台全髋关节置换手术。

Anatomy

解剖特点

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

髋关节是人体最大的关节之一。这是一个球窝对接关节。窝是髋臼，属于是大骨盆骨的一部分。球是股骨头，是股骨（大腿骨）上端。

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

球窝的骨表面覆盖的关节软骨，是一缓冲骨端的平滑组织，能使球窝能自由地移动。

A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

滑膜是一些环绕在髋关节的薄组织。在一个健康的髋关节，滑膜可制造少量的液体润滑软骨，使髋关节运动过程中，几乎没有摩擦。

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

韧带（关节囊）把球和窝连接起来，并保证关节的稳定性。

Common Causes of Hip Pain

髋关节疼痛的常见原因

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

慢性髋关节疼痛和功能障碍最常见的原因是关节炎。骨关节炎、类风湿性关节炎、创伤性关节炎是本病的最常见原因。

· Osteoarthritis.This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood

· 骨性关节炎，是一种与年龄有关的“磨损”类型的关节炎。它通常发生50岁及以上或有家族性关节炎病史人群。缓冲髋关节的骨头摩擦的软骨磨损。骨头互相摩擦，造成髋关节疼痛和僵硬。小孩髋关节正在发育，一些轻微的错的动作亦可导致或加重骨关节炎。

· Rheumatoid arthritis.This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis."

· 类风湿性关节炎，是一种自身免疫性疾病，可出现滑膜发炎和增厚。这种慢性炎症能损伤的软骨，导致疼痛和僵硬。类风湿关节炎是“炎症性关节炎”中最常见的一组疾病类型。

· Post-traumatic arthritis.This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.

· 创伤性关节炎，可以出现在一次严重的髋关节损伤或骨折。有可能损坏软骨，随着时间的推移，可出现髋关节疼痛和僵硬。

· Avascular necrosis.An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis. The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.

· 股骨头缺血性坏死，一些髋关节的损伤，如髋关节脱位或骨折，可能会使股骨头的血液供应不足。这就是所谓的股骨头缺血性坏死。缺血可能使骨头表面收缩，导致关节炎。某些疾病也可以造成股骨头缺血性坏死

· Childhood hip disease.Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

· 童年髋关节疾病，一些婴儿和儿童髋关节的问题。即使问题在儿童时期得到成功治疗，但在以后的生活，这些问题仍可以导致关节炎。这是因为髋关节可能无法正常生长，关节面被影响。

A hip with osteoarthritis.

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Description

概述

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

在全髋关节置换（也称为全髋关节造形术），受损的骨和软骨被移除，并用假体代替。

· The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.

· 损坏的股骨头被去除，并被放置到股骨髓腔的金属杆取代。股骨柄可以是用水泥或“打压”进入骨髓腔。

· A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.

· 金属或陶瓷球位于在杆的上半部分。这个球取代损坏的股骨头。

· The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.

· 髋臼受损软骨表面被移除，并用金属臼替换。螺钉或骨水泥有时用于固定髋臼。

· A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

· 塑料、陶瓷或金属垫片插入假体股骨头和髋臼之间，可制造一个更顺滑的接触面。

(Left)The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

（左）全髋关节置换的各个组件。 （中间）各个部件组成一个完整髋关节假体。（右）假体吻合组成一个人工髋关节。

Is Hip Replacement Surgery for You?

髋关节置换手术适合你吗？

The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.

决定做髋关节置换手术需要你、你的家人、你的初级保健医生及你的骨科医生达成共识。做出这个决定的过程中通常是从骨科医生的初步评估开始的。

Candidates for Surgery

手术适应症

There are no absolute age or weight restrictions for total hip replacements.

髋关节置换手术没有绝对的年龄或体重限制。

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

手术的建议是根据病人的疼痛及功能的障碍，而不是年龄。接受全髋关节置换的患者大多是50岁至80，但骨科医生会根据病人各自的实际情况评估。全髋关节置换已在所有年龄段的患者取得成功，从患幼年型关节炎的年轻少年到患退行性关节炎的老年患者。

When Surgery Is Recommended

什么时候会建议行髋关节置换？

There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

你的医生建议你行髋关节置换手术有很多原因。适合行髋关节置换的病人往往有：

· Hip pain that limits everyday activities, such as walking or bending

· 髋关节疼痛限制日常生活，比如走路和弯腰

· Hip pain that continues while resting, either day or night

· 无论白天、黑夜，休息时髋关节持续疼痛

· Stiffness in a hip that limits the ability to move or lift the leg

· 髋关节僵硬限制移动或抬腿的能力

· Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

· 消炎止痛药、物理疗法、或步行支架不能缓解疼痛 

The Orthopaedic Evaluation

骨科评价

An evaluation with an orthopaedic surgeon consists of several components.

骨科医师的评估包括以下几个部分。

· Medical history.Your orthopaedic surgeon will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.

· 病史：骨科医生将收集有关你的健康信息，并询问你的髋关节疼痛的程度，以及它如何影响你进行日常活动的能力。

· Physical examination.This will assess hip mobility, strength, and alignment.

· 查体：检查髋关节的活动度、力量及关节的对合情况

· X-rays.These images help to determine the extent of damage or deformity in your hip.

· X光片：X光片图像有助于确定髋关节损伤或畸形的程度

· Other tests.Occasionally other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.

· 其他检查：.其他检查如磁共振成像扫描（MRI），有时也可以根据需要来评估骨和臀部的软组织的状况。

(Left)In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space and bone spurs.

（左）正常髋关节的X光片，球窝之间的空间有健康的软骨。 （右）有关节炎的髋关节X光片显示关节间隙变窄和骨刺。

Deciding to Have Hip Replacement Surgery

决定做全髋关节置换手术

Talk With Your Doctor

告诉你的医生

Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

你的骨科医生将评估你的检查结果，并讨论髋关节置换手术是否是减轻你的疼痛，改善你的关节活动性的最好方法。其他的治疗方案 - 如药物治疗，物理治疗，或其他类型的手术 - 也可以考虑。

In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

此外，你的骨科医生会解释潜在的髋关节置换手术的风险和并发症，包括术中和术后可能发生的情况。

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

当你不懂时，永远要毫不犹豫地去问你的医生。你知道得越多，就越能使髋关节置换手术更好的改变你的生活。

Realistic Expectations

手术期望

An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

决定是否行髋关节置换手术的一个重要因素是了解这个手术可以和不能做什么。大多数接受髋关节置换手术的患者可以很大程度的减少髋部疼痛，并使其日常生活的能力有显著改善。

With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports

在日常使用和活动中，头和髋臼之间植入的材料开始磨损。过度活动或超重可能加快这一正常磨损过程，导致髋关节假体松动，并产生疼痛。所以，大多数骨科医生建议避免高强度的活动，如跑步，慢跑，跳跃，或其他高强度运动.

Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

全髋关节置换术后可以进行的活动包括散步，游泳，高尔夫，驾车，远足，骑自行车，跳舞，和其他低强度的运动。

With appropriate activity modification, hip replacements can last for many years.

适当的活动限制可使髋关节置换假体持续使用很多年。

Preparing for Surgery

手术准备

Medical Evaluation

医疗评估

If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.

如果你决定要行髋关节置换手术，你的骨科医生可能会在你的手术之前要求您通过您的主诊医生有一个完整的身体检查。这是为确保你身体足够承受手术并完成恢复过程。许多患者有心脏病等慢性疾病，也可以由专家进行评估，例如在手术前进行心脏评估。

Tests

术前检查

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.

许多检查在手术前是必须的，例如血、尿常规，心电图还有胸片等

Preparing Your Skin

皮肤准备

Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.

你的皮肤手术前不应该有任何感染或过敏。如果有，请让您的骨科医生进行治疗，以在手术前改善你的皮肤。

Blood Donations

捐血

You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.

建议你在手术前预先捐献自己的血液。术后需要血液方能用到。

Medications

药物

Tell your orthopaedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.

告诉你的骨科医生你正在服用的药物，他或她，或您的主诊医生会告诉你，在手术前，哪些你应该停止服用，哪些可以继续服用。

Weight Loss

减肥

If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

如果你体重过重，你的医生可能会要求你在手术前要减减肥，以尽量减少对你的新髋关节的压力，并可减少手术的风险。

Dental Evaluation

牙科评估

Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.

虽然髋关节置换术后感染不常见，如果细菌进入你的血液，感染就可能发生。因为细菌可以在牙科治疗过程进入血液，主要的牙科手术（如拔牙和牙周工作）应在你的髋关节置换手术前完成。你的牙齿日常清洁，应推迟在术后数周后进行。

Urinary Evaluation

泌尿系评估

Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before having surgery.

最近或经常有尿路感染的病史的患者在手术前应该有一个泌尿评价。有前列腺疾病的老年男性应在手术治疗前应完成必要的治疗。

Social Planning

社会生活计划

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.

虽然你可以在手术后不久靠拐杖或助行器走路，你还是需要几个星期的帮助，例如烹饪，购物，洗澡，洗衣等。

If you live alone, your orthopaedic surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.

如果你独自生活，你的骨科医生办公室、社会工作者或者医院的出院处可以帮助你在家的时候得到他人的帮助。也可以在你术后的恢复过程把你暂时安排在一个有充分护理设施的地方。

Home Planning

家庭计划

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

一些改动可以让你的家在你的恢复过程中更轻松地进行导航。下列项目可以帮助你的日常活动：

· Securely fastened safety bars or handrails in your shower or bath

· 在你淋浴器或浴缸安装牢固的安全扶手或扶手

· Secure handrails along all stairways

· 所有楼梯都安装安全扶手

· A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms

· 你早期的康复需要一张有坚固的座垫的稳定的椅子（让你的膝盖仍然维持在你的髋部以下），这张椅子要有一个坚定的靠背以及两个扶手。

· A raised toilet seat

· 一个加高的马桶座圈

· A stable shower bench or chair for bathing

· 稳定的淋浴板凳或椅子洗澡

· A long-handled sponge and shower hose

· 一个长柄的海绵和淋浴软管

· A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip

· 量身定制的敷料、袜子援助和长柄鞋拔使你在穿脱鞋袜的时候不会过度弯曲你的新髋关节

· A reacher that will allow you to grab objects without excessive bending of your hips

· 一个让你可以在不过度弯曲你的新髋关节的情况下就可以拿东西的工具。

· Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips

· 你的椅子、沙发还有汽车需要坚固的枕头保持你的膝盖低于你的髋部。

· Removal of all loose carpets and electrical cords from the areas where you walk in your home

· 在你家里活动的区域去除所有松动的地毯和电线

Set up a "recovery center" where you will spend most of your time. Things like the phone, television remote control, reading materials, and medications should all be within reach.

成立一个“康复中心”，大部分时间你会在那里度过。如手机，电视机遥控器，阅读材料和药物都应该唾手可得。

Your Surgery

手术

You will most likely be admitted to the hospital on the day of your surgery.

你最有可能在你手术的那天被收入院。

Anesthesia

麻醉

After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

入院后，你的麻醉团队成员将会对你进行评估。麻醉中最常见的类型是全身麻醉（你进入睡眠状态）或脊髓，硬膜外或区域神经阻滞麻醉（你是清醒的，但你的身体从腰部以下无感觉）。麻醉团队会根据你的具体情况决定麻醉的哪种类型是最适合你的。

Implant Components

植入假体

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell).

许多不同类型的人工髋关节设计和材料在目前均有使用。所有这些由两个基本部分组成：球部件（由高度抛光的强的金属或陶瓷材料制成的）和柄部件（持久塑料杯，陶瓷或金属，也可以有外金属壳）。

The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.

假体可能是被“压入”骨头并让你的骨在部件周围生长，也可以固定在那里。决定打压或用水泥固定基于许多因素，如您的骨的质量与强度。也可以使用水泥与非水泥混合的柄。

Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.

你的骨科医生会选择最符合您的需要的假体类型

(Left)A standard non-cemented femoral component. (Center) A close-up of this component showing the porous surface for bone ingrowth. (Right) The femoral component and the acetabular component working together.

（左）标准的非骨水泥股骨组件。（中）一个特写镜头显示这部分的多孔表面以便骨往里头生长。（右）股骨假体和髋臼组件一起工作。

(Left)The acetabular component shows the plastic (polyethylene) liner inside the metal shell. (Right) The porous surface of this acetabular component allows for bone ingrowth.

（左）有金属外壳的塑料（聚乙烯）衬里的髋臼假体。 （右）这髋臼假体的多孔表面允许骨长入。

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