应用锥形沟槽式组配柄行股骨侧翻修术后的中远期疗效观察

目的探讨采用锥形沟槽式组配柄假体行股骨侧翻修术后的中、远期疗效。方法 2000年5月至2009年3月采用锥形沟槽式组配柄行翻修手术21例(23髋),男6例,女15例,单髋19例,双髋2例,年龄47~86岁(平均67岁)。股骨侧骨缺损按Paprosky标准,诊断为Ⅱ型缺损者4髋,Ⅲa型缺损者16髋,Ⅲb缺损者3髋。所有患者的股骨侧和髋臼侧手术均分别采用利马锥形沟槽式组配柄假体和SPH臼杯假体行生物学固定翻修,其中头臼界面采用陶瓷-陶瓷者20髋,金属-聚乙烯者3髋。结果所有患者获平均8.8年(6~13年)的随访。Harris评分由术前的平均(46.2±8.2)分改善至手术半年后的平均(90.3±3.7)分,而末次随访仍维持在平均(91.3±3.8)分,与术前比较差异有统计学意义(t=54.50,P0.01)。所有患者的下肢不等长均由术前的平均3 cm减少到术后的平均0.5 cm。手术后下地行走时出现轻度大腿疼痛(VAS评分1~3分)者3髋(13%),但该症状多在术后1年消失。随访X线片显示翻修柄获广泛骨长入达骨性稳定者22髋(96%),翻修柄周围显示有区域性X线透亮带,但无临床松动症状,符合纤维性稳定者1髋。股骨延长截骨者(4髋)、股骨大转子撕脱性骨折者(3髋)和股骨皮质穿透性骨折者(4髋)大多在翻修术后4~6个月获得愈合。所有患者的近段骨缺损植骨区均显示有广泛的骨修复。结论采用锥形沟槽式组配柄假体行股骨侧翻修术后的中、远期疗效满意。     

生物型组配式锥形柄行全髋关节翻修术的中远期疗效

目的探讨应用生物型组配式锥形柄行全髋关节翻修术的中、远期疗效。 方法收集苏州大学附属第一医院2000年5月至2011年5月因假体无菌性松动、股骨侧骨缺损而采用生物型组配式锥形柄行全髋关节翻修手术的患者,排除肿瘤、假体感染及随访时间<5年的患者,共收录37例(39髋),其中采用利马股骨翻修柄19例(21髋),林克(LINK)MP翻修柄18例(18髋)。初次置换至翻修时间为4～15年,平均(10±4)年,均为首次翻修。股骨侧骨缺损分型按Paprosky标准：Ⅲa型28髋,Ⅲb型11髋。摩擦界面均使用陶瓷－陶瓷界面。Harris评分比较采用t检验,骨缺损程度分型组间差异采用卡方检验。 结果全部病例随访6～16年,其中11例随访6～10年,26例随访超过10年,平均(11.6±2.3)年。两种假体翻修时股骨缺损程度未见明显差异(χ²＝0.434; P>0.05)。术前平均Harris髋关节评分为(43±10)分,末次随访为(90±3)分(t＝32.334,P<0.05),两种翻修假体的临床疗效差异无统计学意义(t＝0.881,P>0.05)。X线随访显示翻修柄骨性稳定者38髋(97.4%),纤维稳定者1髋(2.6%)。假体平均下沉(2.1±2.3) mm(0～10 mm)。随访期间无1例因假体松动或其他原因需行再次翻修。 结论采用生物型组配式锥形柄假体行伴有Paprosky Ⅲa和Ⅲb型骨缺损的股骨侧假体翻修,可获得理想的初始稳定和永久生物学固定,中、远期随访疗效满意。     

全髋翻修术后组配式与一体式假体下沉率比较

股骨柄假体下沉可以导致松动、不稳、下肢不等长等并发症。带沟槽的钛合金股骨柄广泛应用于全髋翻修术。作者回顾性分析了186例全髋翻修术病例资料,包括106例一体式和80例组配式股骨假体,随访3个月~3年。结果发现,组配式股骨柄假体下沉率显著高于一体式股骨柄假体(3.9 mm±2.6 mm vs 2.3 mm±2.5 mm,P<0.001);组配式股骨柄假体>5 mm的下沉发生率显著高于一体式股骨柄假体(29.2%vs 11.3%,P<0.001)。因此作者认为,在进行全髋置换术选择假体时必须权衡组配式股骨柄假体的优、缺点。     

组配式S-ROM假体在髋关节发育不良及髋关节翻修术中的应用进展

目的总结S-ROM(Sivash-range of motion femoral modular stem)假体设计及生物力学特点,以及在髋关节发育不良(developmental dysplasia of hip,DDH)的关节置换及髋关节翻修术中的应用进展。方法广泛查阅近年S-ROM假体的相关文献,并进行综合分析。结果 S-ROM假体利用其组配性可以在股骨近端与远端同时达到紧密压配,适用于存在股骨解剖差异以及需行股骨截骨矫形的DDH人工全髋关节置换,以及伴骨缺损的髋关节翻修。结论 S-ROM假体组配结合部增大了假体折断及产生金属磨屑的可能,其远期疗效需进一步随访明确。     

人工髋关节翻修旋转中心重建的临床研究

目的 探讨在人工髋关节翻修手术中,根据Harris窝及髋臼切迹的残存解剖标记,定位髋臼中心点,正确安装髋臼假体和重建髋关节旋转中心的可行性.方法 2007年4月至2009年6月,行28例髋关节翻修术.依据Paprosky分型:Ⅰ型3例,采用生物固定型髋臼假体;ⅡA和ⅡB型8例,采用打压颗粒骨植骨和大直径骨水泥型髋臼假体固定;ⅡC、ⅢA和ⅢB型17例,采用打压颗粒骨植骨和髋臼加强杯固定,其中5例有髋臼内壁穿透者采用结构性和颗粒性植骨.手术中在髋臼切迹连线的垂直平分线上方25～28mm、Harris窝窝内头侧接近原月状软骨面处,定位为原髋臼中心点,以该点为同心圆的圆心安装髋臼杯假体(Ⅰ型)或打压植骨造臼,按照俯倾角40°～45°、前倾角15°～20°安放髋臼加强杯(Ⅱ、Ⅲ型).手术前后摄双侧髋关节正位X线片,测量髋关节旋转中心至两侧泪滴连线的垂直距离和至泪滴的水平距离.分别与术前和健侧比较,评价髋关节旋转中心的重建效果.结果 髋关节旋转中心至两侧泪滴连线的垂直距离:术前为(32.64±4.51)mm,术后为(14.22±3.39)mm,差异有统计学意义(t=3.65,P＜0.05).髋关节旋转中心至泪滴的水平距离:术前为(25.13±3.46)mm,术后为(32.87±4.73)mm,差异有统计学意义(t=2.72,P＜0.05).结论 在髋关节翻修手术中,以残存的Harris窝和髋臼切迹为解剖标记,定位髋臼中心点,能够较准确地安装髋臼假体和有效重建髋关节旋转中心.

Abstract：

Objective To discuss the feasibility of positioning the acetabular center,fixing acetabular implant correctly and reconstructing hip rotation center according to Harris fossa and the remaining anatomical markers of acetabular notch in revision hip arthroplasty.Methods Twenty-eight patients underwent revision hip arthroplasty from April 2007 to June 2009.Based on Paprosky type,3 cases with type Ⅰ were treated with biological fixed acetabular component;8 cases with ⅡA and ⅡB were reconstructed with using of morselized bone grafting and large diameter cemented acetabular prosthesis;17 cases with type ⅡC,ⅢA and ⅢB were treated with using of morselized bone grafting and fixation of acetabular reinforcement ring.Among them,5 patients with massive bone loss in acetabular wall were reconstructed with the use of the structural and morselized bone grafting.The center of the original acetabulum was believed to be in the lunate cartilage surface which was closed to Harris fossa.During the operation,the center was located in the site which was 25-28 mm above in line with perpendicular bisector of acetabular notch connecting line.The acetabular center was the point of positioning acetabular prosthesis (Ⅰ type) or making new acetabulum by impaction bone grafting.Acetabular reinforcement ring (Ⅱ,Ⅲ type) was fixed in accordance with proper transverse angle and anteversion angle.The vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop were measured on preoperative and postoperative radiograph.And the outcomes of reconstruction of rotation center were evaluated.Results The vertical distance was changed from (14.22±3.39) mm preoperatively to (32.64±4.51) mm postoperatively.The difference was statistically significant (t=3.65,P＜ 0.05).The horizontal distance was changed from (25.13±3.46)mm preoperatively to (32.87±4.73) mm postoperatively.The difference was statistically significant (t=2.72,P＜0.05).Conclusion Using residual Harris fossa and acetabular notch as the anatomical markers in revision hip arthroplasty,the restoration of the anatomical hip center has shown to be favorable.     

组配式假体在Paprosky Ⅲ型股骨近端骨缺损翻修中的应用

[目的]报道应用组配式远端固定生物型假体翻修Paprosky Ⅲ型股骨近端骨缺损的手术要点及疗效. [方法]2003年5月～2006年10月应用MP、ZMR组配式股骨假体翻修Paprosky Ⅲ型股骨近端骨缺损9例,男5例,女4例,年龄39～65岁,平均57岁,术后随防时间8～34个月,平均19个月.翻修原因:7例为骨水泥固定假体松动、骨溶解,2例为珊瑚面假体无菌性松动.原手术到翻修时间最短4年,最长12年.依据Papresky分型,ⅢA型5例,ⅢB型4例. [结果]Harris评分:术前平均35分(28～54分),术后85分(70～90分).7例弃拐行走,2例存在大腿疼痛,其中1例轻度疼痛伴下肢短缩2.5 cm,需扶手杖行走,1例中度疼痛,扶单拐行走、跛行.本组随访过程中均无再松动、感染征象,1例发生假体下沉12 mm,股骨柄远端无骨溶解现象. [结论]组配式远端固定生物型假体可较好完成Paprosky Ⅲ型股骨骨缺损的翻修,能达到初期及后期稳定.由于假体的假体柄与假体近端部分分开,使其植入变得容易,多部件组配可方便解决各种可能问题,如偏心距、前倾角、肢体长度等,明显简化了手术,且手术安全性好,是较理想的股骨翻修假体.     

髓内打压植骨结合广泛多孔涂层长柄假体在股骨侧严重骨缺损（PaproskymA型）翻修术中的应用

目的 探讨股骨侧严重骨缺损（Paprosky ⅢA型）翻修中应用髓内打压植骨结合广泛多孔涂层长柄假体的临床疗效.方法 2006年3月～2010年9月,对38例（38髋）Paprosky ⅢA型股骨骨缺损患者行翻修重建,其中男24例,女14例,平均年龄62岁.翻修原因：骨溶解、无菌性松动29例,全髋关节置换术（THA）术后感染二期翻修6例,假体周围骨折3例（Vancouver B3型）.股骨侧干骺端骨缺损采用同种异体颗粒骨髓腔内打压植骨进行修复,股骨柄采用全涂层长柄假体（7～10英寸）.术后定期随访,髋关节功能评价采用Harris评分,影像学采用X线片及CT观察：假体柄有无松动下沉、股骨近端应力遮挡情况、植入的异体颗粒骨与宿主骨整合情况.结果 38例均获得随访,平均随访53.4个月（23～62个月）,Harris评分由术前平均42分（32～47分）,提高至末次随访时平均86分（69～95分）.无患者发生脱位、假体周围骨折.1例术后感染,行再次二期翻修;1例假体柄在术后6个月内下沉4.24 cm,再次翻修时选择更粗的假体柄,末次随访时假体柄稳定;其余所有患者假体柄均牢固固定.3例出现轻-中度应力遮挡.15例近端皮质骨密度及厚度有增加,厚度平均增加约1.8 mm（0.7～3.5 mm）,植入骨与宿主骨逐渐整合并增加了骨缺损区的骨质储备.结论严重骨缺损（Paprosky ⅢA型）的股骨翻修中,采用髓内颗粒骨打压植骨可以很好的修复股骨中上段骨缺损,重建股骨干骺端.依靠广泛多孔涂层长柄假体在远端的牢固压配固定,结合股骨干骺端髓内紧密打压植骨,使假体柄在股骨中上段及远端均能获得较好的初始稳定性,近期临床和影像学结果满意,远期疗效有待观察.     

双锥面螺旋臼固定治疗髋关节中心性脱位的中长期临床效果分析

目的 探讨使用双锥面螺旋臼假体固定髋关节中心性脱位病例的长期临床效果.方法 1998年5月至2006年9月北京大学人民医院关节病诊疗研究中心对31例髋关节中心性脱位患者的39侧髋关节行人工全髋关节置换术或翻修术,其中男性12例,女性19例.手术时平均年龄为57.6岁(30～82岁).引起髋关节中心性脱位的病因包括:类风湿关节炎3例6髋;股骨头坏死继发髋关节炎7例12髋,人工股骨头置换术后髋臼磨损11例11髋、髋臼假体松动10例10髋.术中髋臼部分均使用双锥面螺旋臼进行生物学固定.术前Harris评分平均为31.0分(14～61分).结果 所有病例均在术后6个月、1年时随访,2例3髋患者分别因肺癌、急性心肌梗死死亡.24例31髋获得随访,平均随访时间7.4年(5.0～11.5年).末次随访时Harris评分平均为84.7分(70～95分).1例股骨头坏死行双髋同时置换患者术后右髋出现感染,行关节取出骨水泥旷置术,但因内科疾病不稳定未再行翻修术.1例类风湿关节炎患者双髋关节分期手术,术后7年随访时左侧髋臼假体有内侧轻度移位,边缘有透亮线,但患者日常功能好,无疼痛.其余所有病例双锥面螺旋臼假体全部存留,患者日常生活功能良好,对手术效果满意.结论 髋关节中心性脱位使用双锥面螺旋臼的固定效果确切,平均超过7.4年的中长期随访结果显示效果良好.

Abstract：

Objective To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli. Methods From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymtüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component Results All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7. 4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84. 7(from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removel prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component,but the patient had no pain with good hip function. All other cases had good hip functions and were very fixations and perfect medium and long-term clinical results for over 7.4 years.     

远端锥形组配式生物股骨柄在股骨翻修术中的应用

目的探讨使用远端锥形组配式生物股骨柄（MP）在股骨翻修中应用的临床效果及经验。方法回顾性分析了21例采用MP远端锥形组配式生物股骨柄翻修患者的影像及临床效果，平均随访2年以上，影像上术前、术后及每次随访时均常规摄髋关节正侧位，临床效果使用Harris评分评测，调查患者满意度。结果Harris评分由术前的平均（56．2±25．2）分上升到术后的（85．3±13．2）分，最后一次随访时上升到（89．2±11．5）分，患者满意度90．5％。20例患者中术后X线片评价上：可观察到骨缺损区的修复，而没有近端骨质吸收和透亮线的增加，锥度连接处没有发生不良并发症，这20例患者术后即获得初次稳定性，另1例因感染未彻底清除而发生了假体下沉进行了再次翻修手术。结论MP远端锥形组配式生物股骨柄翻修取得了令人鼓舞的结果，远端生物固定的理念可以解决绝大多数少于Paprosky ⅢB的骨缺损患者。     

Wagner SL股骨柄用于髋关节翻修的适应证及疗效

[目的]通过临床病例总结,观察非组配型股骨柄Wagner SL用于国人髋关节翻修的初期临床疗效。[方法]2010年1月~2012年12月,共32例患者翻修术中使用单体型Wagner SL股骨柄。全髋术后股骨骨缺损按Paprosky分型,其中Ⅱ型19例,Ⅲa型11例,Ⅲb型2例。5例未行髋臼侧翻修。对每例患者术前术后进行Harris评分。通过双侧髋关节正位X线片测量评估肢体长度差异(Leg Length Discrepancy,LLD)。假体下沉的评估使用Callaghan等的方法。[结果]随访18~42个月,平均随访29.3个月。术前Harris评分(34.5±36.8)分,术后Harris评分平均(81.5±23.1)分。8例患者末次复查假体下沉≥5~10 mm;1例复查股骨假体下沉10 mm。均无明显症状。2例术后早期脱位。LLD:术前LLD≥2 cm 7例,≥1 cm 22例。术后末次随访LLD≥2 cm 2例,≥1 cm 8例,≥0.5 cm 17例。术后肢体差异较术前平均减小0.80 cm(1.8~-0.8 cm)。[结论]本组病例证实Wagner SL用于股骨侧Ⅱ,Ⅲa、Ⅲb型骨缺损翻修病例及部分假体周围骨折病例取得良好的初期效果,但在肢体长度差异调节准确性不足。     

Radiographic and Clinical Outcomes of Modular Tapered Fluted Stems for Femoral Revision for Paprosky III and IV Femoral Defects or Vancouver B2 and B3 Femoral Fractures

BackgroundExtensive femoral bone loss poses a challenge in revision total hip arthroplasty (rTHA). Many techniques have been developed to address this problem including fully porous cylindrical stems, impaction bone grafting, and cementation of long stems, which have had varied success. Modular tapered fluted femoral stems (MTFS) show favorable results. We sought to determine the minimum 2-year radiographic and clinical performance of MTFS in rTHA in a population with extensive proximal femoral bone loss.MethodsOur clinical database was queried retrospectively for all patients who underwent rTHA with an MTFS. We included patients with Paprosky 3 and 4 femoral bone loss and patients with Vancouver B2 and B3 periprosthetic femur fractures. Patients without 2-year follow-up were invited to return to clinic for X-ray evaluation and to complete clinical questionnaires. We assessed distance of stem subsidence and presence of stem fixation on final X-ray. We recorded all-cause revision and survival of the stem at final follow-up.ResultsOne hundred twenty-nine patients were available for follow-up. Average follow-up time was 3.75 years. One hundred twenty-two stems (95%) remained in place at final follow-up. Median subsidence was 1.4 mm (range 0-21). All-cause revision rate was 16.3% (21 patients). Of the hips revised, 10 were for instability, 6 for infection, 1 for aseptic loosening, and 1 for periprosthetic femur fracture. Three were revised for other reasons. The stem was revised in 7 patients (5.4%), and the most common reason for stem revision was infection (5 patients). The other 2 stems were revised for aseptic loosening in a Paprosky 4 femur and periprosthetic femur fracture. Survival of tapered modular fluted stems with aseptic failure as an endpoint was 98.4%. The mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement score at final follow-up was 73, and mean Veterans Rand 12 item health survey physical and mental scores were 32.8 and 52.2, respectively.ConclusionIn patients with Paprosky 3, 4 femoral defects or Vancouver type B2, B3 fractures, modular tapered fluted stems for femoral revision show excellent outcomes at minimum 2-year follow-up.     

Long-Term Outcomes of Revision Total Hip Arthroplasty Using a Tapered and Fluted Modular Stem: A Mean Follow-Up of 16 Years

BackgroundTapered modular stems are increasingly used in revision total hip arthroplasty (THA) with deficient femoral bone stock. This study aimed to report the long-term outcomes of revision THA using a tapered and fluted modular stem.MethodsBetween December 1998 and February 2006, 113 revision THAs (110 patients) were performed with a tapered and fluted modular stem at a single institution. Hip radiographs were used to identify stem subsidence, stability, and femoral radiolucency. Final outcomes were assessed in 72 hips (70 patients), with a minimum follow-up of 10 years.ResultsThe mean follow-up duration was 16 years (range, 10-23). At the final evaluation, the Harris Hip Score improved from a mean of 41 points (range, 10-72) preoperatively to 83 points (range, 56-100) (P < .001). Six femoral re-revisions were performed for the following reasons: 1 aseptic loosening, 2 stem fractures, and 3 infections. One stem fracture occurred at the modular junction after 14 years, and the other at a more distal location after 15 years. Stem subsidence was >5 mm in 6 hips (9.1%), but secondary stability was achieved in all stems. Osseointegration was observed in 63 (95.5%) hips. Stem survivorship was 91.1% with an end point of any re-revision and 94.6% for aseptic re-revision.ConclusionA tapered and fluted modular stem demonstrated excellent implant survivorship with reliable bony fixation at a mean follow-up of 16 years. This type of stem can be a durable option for revision THA in patients who have femoral defects.     

3D技术辅助钽金属块植入修复严重髋臼骨缺损的早期疗效

目的探讨髋关节翻修术中应用3D技术辅助植入钽金属块治疗PaproskyⅢ型髋臼骨缺损的早期临床疗效。方法回顾性分析2013年5月至2017年7月收治的伴有PaproskyⅢ型髋臼骨缺损的髋关节翻修术16例(18髋),男11例,女5例;年龄(58.06±8.29)岁(范围44~69岁)。感染性松动3髋,无菌性松动15髋;PaproskyⅢA型骨缺损13髋,ⅢB型骨缺损5髋。术前使用3D技术进行精确规划,术中应用钽金属块和臼杯修复髋臼骨缺损。测量并比较手术前后髋关节臼杯的前倾角、外展角、患侧与对侧旋转中心垂直距离比值、旋转中心水平距离比值、股骨偏心距比值的差异,比较手术前后臼杯位于Lewinnek安全区内的比例,观察术后髋关节影像学松动的表现。采用Harris髋关节评分评价术后6个月及末次随访时的髋关节功能。结果臼杯位于lewinnek安全区内的比例由术前的22%(4/18)提高至术后的61%(11/18),差异有统计学意义(P=0.018)。术后患侧髋臼前倾角为11.99°±6.91°(范围1.71°~26.36°),外展角为44.91°±5.93°(范围35.6°~56.0°);患侧与对侧旋转中心垂直距离比值为1.10±0.20(范围0.87~1.62)、水平距离比值为1.00±0.18(范围0.69~1.46)、股骨偏心距比值为1.01±0.66(范围0.51~3.56)。所有患者均获得随访,随访时间为(27.72±12.18)个月(范围14~53个月)。术后6个月Harris髋关节评分为(77.28±4.80)分(范围65~85分),末次随访时为(80.9±5.2)分(范围69~89分)。随访期间所有患者均未出现假体周围感染、脱位及无菌性松动等并发症。结论3D技术辅助钽金属块植入修复严重髋臼骨缺损能够提高髋关节假体安放的准确性,术后早期假体稳定无松动,有利于髋关节功能的恢复。     

钽金属臼杯重建髋臼骨缺损的近期疗效

 目的 探讨应用钽金属臼杯对不同类型髋臼骨缺损进行重建的近期疗效。方法 回顾性分析2009年8月至2012年4月在全髋关节置换术中使用钽金属臼杯重建髋臼骨缺损的连续21例患者的病例资料,男6例,女15例;年龄24~78岁,平均(53.7±16.2)岁。初次全髋关节置换5例：Crowe Ⅳ型髋关节发育不良2例、髋关节感染后遗高位脱位畸形2例、类风湿关节炎1例;全髋关节翻修16例：全髋关节置换术后感染二期翻修2例、髋臼金属炎性假瘤3例、假体无菌性松动11例。骨缺损Paprosky分型Ⅰ型9例,Ⅱa型4例,Ⅱb型5例,Ⅱc型1例,Ⅲa型1例,Ⅲb型1例。观察术后髋臼假体周围透光线、假体位置、生存率、并发症及Harris髋关节评分。结果 全部病例随访6~40个月,平均20.1个月。末次随访时PaproskyⅠ型患者的Harris髋关节评分(87.2±7.4)分,高于术前(41.1±6.3)分;Ⅱ型(79.8±11.8)分,高于术前(38.4±12.5)分;Ⅲ型为79分,高于术前24分。随访期间钽金属臼杯固定良好,未出现松动及移位,假体生存率100%。按照Anderson骨长入影像学评价标准,髋臼杯均出现不同程度骨长入。1例于DeLee-Charnley髋臼3区出现透光线,4个月后消失;1例于髋臼1区出现假体周围间隙,随访6个月未进展。1例于术后4周出现后脱位。结论 应用钽金属臼杯重建PaproskyⅠ、Ⅱ型髋臼骨缺损,能实现早期与宿主骨整合,近期疗效好。     

远端固定生物型假体在股骨翻修术中的应用

目的探讨远端固定生物型假体结合干燥同种异体骨植骨在近端骨缺损股骨翻修术中的应用疗效。方法自1999年7月至2004年1月,对16例（17髋）非感染性股骨假体松动患者进行翻修手术,其中2例为再次翻修,采用远端固定生物型股骨假体结合干燥同种异体骨植骨。男7例,女9例,年龄58～77岁,平均63岁,术后平均随访时间为35个月（18～56个月）。翻修前人工股骨头置换5例,全髋关节置换12例,从初次关节置换到翻修手术的间隔时间最短7年,最长16年,平均13．5年。股骨骨缺损根据Paprosky分型,Ⅰ型8髋,Ⅱ型6髋,ⅢA型3髋。翻修用假体：MP（Link）1髋,AML（DePuy）9髋,Full—coated（Zimmer）5髋,Enchelon（Smith—Nephew）股骨距替代型假体2髋。结果Harris评分从术前平均37分改善至术后平均88分,无患者发生再次松动。术后X线片显示植入骨愈合良好,假体部位骨皮质密度和厚度明显增加。结论远端固定生物型假体可以在股骨远端髓腔内获得可靠的轴向及抗旋转初始稳定性,干燥异体骨植骨能有效修复骨缺损,恢复骨量,骨愈合率高,两者结合运用于伴有近端骨缺损的股骨翻修术中,中短期疗效满意,远期疗效尚待进一步随访。     

High complication rate in reconstruction of Paprosky type IIIa acetabular defects using an oblong implant with modular side plates and a hook

We report the results of 62 hips in 62 patients (17 males, 45 females) with mean age of 62.4?years (37 to 81), who underwent revision of the acetabular component of a total hip replacement due to aseptic loosening between May 2003 and November 2007. All hips had a Paprosky type IIIa acetabular defect. Acetabular revision was undertaken using a Procotyl E cementless oblong implant with modular side plates and a hook combined with impaction allografting. At a mean follow-up of 60.5 months (36 to 94) with no patients lost to follow-up and one died due to unrelated illness, the complication rate was 38.7%. Complications included aseptic loosening (19 hips), deep infection (3 hips), broken hook and side plate (one hip) and a femoral nerve palsy (one hip). Further revision of the acetabular component was required in 18 hips (29.0%) and a further four hips (6.4%) are currently loose and awaiting revision. We observed unacceptably high rates of complication and failure in our group of patients and cannot recommend this implant or technique.     

人工髋关节置换术后感染二期关节再置换的假体选择

目的 探讨人工髋关节置换术后感染二期关节再置换的假体选择.方法 1999年1月至2007年12月,共32例单侧人工髋关节置换术后感染二期关节再置换的患者,男19例,女13例,平均56岁(32～80岁).髋臼侧Paprosky骨缺损分型:Ⅰ型13例,ⅡA型9例,ⅡC型5例,ⅢA型1例,ⅢB型4例;对Ⅰ～ⅡA型髋臼骨缺损(22例),应用非骨水泥型假体;对ⅡC～ⅢB型髋臼骨缺损(10例),给予植骨、加强环和髋臼网等方法进行充分重建,应用骨水泥型假体.股骨侧Paprosky骨缺损分型:Ⅰ型11例,Ⅱ A型4例,ⅡB型1例,ⅡC型5例,ⅢA型6例,ⅢB型3例,ⅢC型2例;选用骨水泥型假体8例(ⅡC型5例,ⅢB型3例),近端固定生物型假体5例(Ⅰ型),广泛涂层型假体11例(Ⅰ型6例,ⅡA型4例,ⅡB型1例),远端同定型假体8例(ⅢA型6例,ⅢC型2例).结果 术后随访1～10年,平均5年2个月.术后2例患者反复发生感染,因患者拒绝再次取出假体,仅行清创和保守治疗;末次随访时仍存在窦道;Harris评分分别为65和78分.其余30例患者效果满意,Harris评分由二期手术前的平均48分(31～78分)提高到术后平均85分(80～95分).末次随访时X线片与术后当时的X线片对比,30例患者的假体均无下沉、移位和松动.结论 人工髋关节置换术后感染二期关节再置换手术的成功率高,手术重点是确认感染已获得良好控制后,针对骨缺损类型选择相应的假体.     

Cementless Modular Total Hip Arthroplasty in Patients Younger than Fifty with Femoral Head Osteonecrosis: Minimum Fifteen-Year Follow-Up

This study aimed to report the outcome of total hip arthroplasty (THA) with a modular femoral component in patients younger than fifty years with osteonecrosis of femoral head. Sixty-four osteonecrotic hips in fifty-five patients were available for clinical and radiographic analyses at minimum follow-up of fifteen-years. The mean Harris hip score improved from 36 points preoperatively to 92.7 points at final follow-up. Sixty-two (95.3%) hips demonstrated stable bone ingrowth. No hips showed loosening or required revision for aseptic loosening. Survivorship with an end point of stem revision for any reason was 93.8% and for aseptic loosening was 100% at 16.8 years. We believe that cementless THA with a modular stem is a promising procedure for young and active patients with osteonecrosis of the femoral head.     

Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up

Purpose

Modular acetabular reconstructive cups have been introduced in an attempt to offer initial rigid fixation by iliac lag screws and ischial pegs, to support bone grafts with a flanged metal socket, and to restore original hip center in acetabular revision. The purpose of this study was to clarify minimum ten year follow-up results of this cup system with morsellised allografts in revision cases.

Methods

We retrospectively investigated 54 acetabular revisions at a mean of 11 years (range, ten to 14 years). The indications were Paprosky’s type 2B (eight hip), 2C (eight hips), 3A (23 hips), 3B (nine hips), and 4 (six hips).

Results

Using aseptic loosening as the endpoints, the survival rate was 89.3 % (95 % CI 81–98). Radiographically, one type 3A hip, three type 3B hips and one type 4 hip showed aseptic loosening while no type 2 hips or no cemented cups showed loosening.

Conclusions

The modular reconstructive cups for acetabular revision showed bone stock restoration and stable implantation.