陶瓷-陶瓷全髋关节置换术中大小直径股骨头的早期比较

[目的]分析陶瓷-陶瓷全髋关节置换术中分别应用不同直径的股骨头的临床效果,并作相应的比较.[方法]2008年9月～2009年10月,本院共施行136例(157髋)陶瓷-陶瓷全髋关节置换术,其中男59例(68髋),女77例(89髋),年龄27～81岁(平均61.3岁);均采用德国LINK BetaCupTm复合陶瓷界面非骨水泥压配固定髋臼系统进行全髋关节置换;术前诊断显示股骨头缺血性坏死76髋,发育性髋关节脱位46髋,骨关节炎15髋,强直性脊柱炎11髋,类风湿性关节炎3髋,股骨颈骨折GardenⅣ型6髋.术中根据髋臼磨挫直径大小选择相应的股骨头假体(直径分别为28,32,36 mm),根据股骨头假体的直径大小分为3组,Ф28 mm组69髋,(Ф32 mm组31髋,Ф36 mm组57髋,通过术前及术后的Harris评分了解髋关节功能及疼痛的改善情况.[结果]随访时间12～18个月(平均16.2个月),(Ф28 mm、Ф32 mm、Ф36 mm股骨头术前Harris总评分、疼痛评分、功能评分、活动范围评分比较无明显差异(P>0.05),术后Harris总评分、疼痛评分、功能评分比较无明显差异(P>0.05),每组术后Harris评分较术前明显改善(P<0.05),股骨头直径越大术后活动范围改善就越明显(P<0.05).[结论]陶瓷-陶瓷全髋关节置换术股骨头直径的选择对术后疼痛的缓解差异性并无影响,但在髋关节活动范围改善方面大直径的球头要优于小直径的球头.陶瓷-陶瓷全髋关节置换术对手术技术及患者自身条件的要求较高,不可盲目追求大直径而忽略髋臼的实际承载条件.     

保留股骨侧假体的髋关节翻修的临床疗效评析

目的探讨在髋关节翻修中保留股骨侧假体、单纯行髋臼侧翻修的短中期疗效。方法对2005年2月至2013年1月间采用保留股骨侧假体、单纯行髋臼侧假体翻修的31例31髋进行回顾性分析,其中男17例,女14例;年龄48~77岁,平均(64.32±8.76)岁。髋臼侧内衬磨损、无菌性松动、移位26例,髋关节脱位3例,髋臼骨折2例。股骨侧采用骨水泥固定的12例,生物固定的19例。进行翻修手术距离初次手术3个月~13年,平均(56.65±40.19)个月。18例翻修用髋臼与股骨侧假体保持同一厂家,13例因产品原因更换厂家。术中常规先行股骨侧假体稳定性的测试,评估股骨侧假体位置,对于股骨近端存在骨溶解的病例,溶解骨清理后进行打压植骨,单纯行髋臼侧翻修,采用Harris评分和X线片对其临床效果进行评估。结果术后随访12~103个月,平均(53.94±22.89)个月,Harris评分由翻修前平均(40.29±7.88)分增加至术后平均(86.42±5.2)分。所有患者无感染及关节脱位,未见假体移位,没有再翻修病例。结论全髋翻修中,根据患者年龄情况、股骨侧假体的固定情况、骨溶解的情况、初次置换假体选择情况、初次置换与翻修手术间隔时间情况,对部分患者采用保留股骨侧假体、单纯行髋臼侧翻修,可减少手术创伤,短中期随访效果满意。     

应用双极人工股骨头和骨移植进行髋臼假体翻修术

目的 分析双极人工股骨头和嵌压植骨联合应用对合并巨大骨缺损的髋臼侧假体进行翻修术的临床疗效。方法 1988年3月－2000年11月期间利用双极人工股骨头对合并巨大骨缺损的23例24髋进行髋臼侧假体翻修术。其中男15例，女8例，平均年龄48岁，平均随访6．4年。翻修术的原因中假体松动21髋，骨溶解2髋，感染1髋，髋臼骨缺损根据AAOS分类，I型3髋，Ⅱ型6髋，Ⅲ型15髋。自体骨移植2髋，异体骨移植8髋，混合移植14髋。临床评价采用Harris评分，并在X线片上对髋臼假体的移位，移植骨的愈合与吸收，髋臼形态的塑形以及再次翻修等进行分析。结果 Harris评分术前为49分，术后1年为78分，最后随访时间为76分。髋臼假体向上内方向移位19髋，向上外方向移位5髋。并发症中异位骨化12髋，感染1髋，复发性脱位1髋。因感染和髋臼假体严重移位采用非骨水泥型髋臼假体行再次翻修术2髋。结论 双极人工股骨头和嵌压植骨联合应用对合并巨大骨缺损的髋臼侧假体进行翻修术具有髋臼形态塑形良好，移植骨愈合率高以及髋臼假体不需要坚强内固定等优点，可作为一种特殊情况的髋臼侧假翻修术；其缺点是髋臼假体移位。     

人工全髋关节翻修术治疗假体置换术后感染

目的：探讨全髋关节置换术后假体周围感染的治疗方法。方法：1998年1月～2002年6月共收治7例全髋关节置换术后感染患者。采用一期全髋关节翻修术3例，二期全髋关节翻修术4例，术后平均随访14个月。结果：患者髋关节评分平均提高37．6分(Harris评分)，经随访无一例感染患者复发。结论：人工全髋关节置换术后感染患者经过彻底清创和使用有效抗生素治疗后，可一期或二期进行全髋关节翻修术，治疗假体周围感染，改善患肢关节功能。     

全髋关节翻修术中股骨骨缺损的处理和假体的选择

近年来,随着全髋关节置换术（total hip anhroplasty,THA）的广泛开展,THA的指征有所扩大,进行关节置换的患者也日趋低龄化,手术数量不断提高,相应的也有越来越多的患者需要进行翻修。据统计,2000年美国共进行了183000例THA,其中将近17％（31000）是翻修手术。而Kurlz等报道从1990年到2002年间,英国全髋翻修手术增加了60％。     

交锁翻修柄在股骨侧假体翻修术的应用

目的 报道采用交锁翻修柄(Bicontact和Kent)进行在全髋关节股骨侧假体翻修手术的疗效。方法 12例股骨侧假体翻修手术(假体松动5例，假体周围骨折7例)均采用现代无骨水泥技术，Bictintact翻修柄8例，Kent翻修假体4例，结合金属网、钢丝线缆握紧系统器械和异体骨移植进行结构重建。结果 平均随访8．40个月，功能优良10例(83．34％)，可1例(8．33％)，差1例(8．33％)，后出现Bicontact假体柄断裂和股骨干骨折。结论 在老年患股骨侧假体翻修术中，运用交锁翻修柄(Bicontact和Kent)能使手术时间和创伤减少，股骨侧固定快且牢固，并允许患早期进行功能锻炼；在股骨近端广泛骨缺失而需要大块异体骨移植进行重建的情况下，交锁翻修柄解决了既往各种假体较难固定于异体植骨块和残留的受体股骨中的问题。     

应用双极人工股骨头和骨移植进行髋臼假体翻修术

目的分析双极人工股骨头和嵌压植骨联合应用对合并巨大骨缺损的髋臼侧假体进行翻修术的临床疗效.方法 1988年3月～2000年11月期间利用双极人工股骨头对合并巨大骨缺损的23例24髋进行髋臼侧假体翻修术.其中男15例,女8例,平均年龄48岁,平均随访6.4年.翻修术的原因中假体松动21髋,骨溶解2髋,感染1髋.髋臼骨缺损根据AAOS分类,Ⅰ型3髋,Ⅱ型6髋,Ⅲ型15髋.自体骨移植2髋,异体骨移植8髋,混合移植14髋.临床评价采用Harris评分,并在X线片上对髋臼假体的移位、移植骨的愈合与吸收、髋臼形态的塑形以及再次翻修等进行分析.结果 Harris评分术前为49分,术后1年为78分,最后随访时间为76分.髋臼假体向上内方向移位19髋,向上外方向移位5髋.并发症中异位骨化12髋,感染1髋,复发性脱位1髋.因感染和髋臼假体严重移位采用非骨水泥型髋臼假体行再次翻修术2髋.结论双极人工股骨头和嵌压植骨联合应用对合并巨大骨缺损的髋臼侧假体进行翻修术具有髋臼形态塑形良好、移植骨愈合率高以及髋臼假体不需要坚强内固定等优点,可作为一种特殊情况下的髋臼侧假体翻修术;其缺点是髋臼假体移位.     

股骨头假体直径与全髋关节置换术后脱位的关系

[目的]研究初次全髋关节置换术后股骨头直径对髋关节脱位的影响,为临床选择理想直径的股骨头假体提供依据。[方法]收集本院和苏州大学附属第一医院骨科自1990年3月~2008年8月期间,采用不同直径的股骨头假体行初次全髋置换术706例(762髋)的病案资料。男性301例,女性405例;年龄21~78岁,平均57岁。术前诊断:股骨头坏死203例,先髋继发骨性关节炎129例(其中Crowe Ⅳ型15例),股骨颈骨折190例,创伤后骨关节炎112例,类风湿强直性脊柱炎58例,结核继发骨性关节炎13例,化脓性髋关节炎融合术后1例。股骨头假体采用22 mm直径者220髋,26 mm直径83髋,28 mm直径459髋。95%手术入路为改良Hard ing入路,5%手术入路为后外侧入路。[结果]全部患者均获得至少6个月的随访,762髋中术后发生脱位28髋,总体脱位率为3.7%。其中股骨头假体直径为22 mm的220髋中,发生脱位者16髋,脱位率为7.3%,股骨头假体直径为26 mm的83髋中,发生脱位4例,脱位率为4.8%,而股骨头假体直径为28 mm的459髋中,发生脱位者8例,脱位率为1.7%。将假体头直径在22、26和28 mm三组脱位率进行统计学分析,发现有统计学差异(x2=13.193,P=0.001;R=0.131,P=0(0.01)。[结论]股骨头直径是影响初次全髋关节置换术后脱位的主要因素之一,直径越大,脱位率越低,反之则脱位率越高。     

全髋关节翻修术中髋臼骨缺损的处理方法

目的探讨全髋关节翻修术中对于髋臼骨缺损重建的方法及其术后疗效。方法回顾性分析自2007-03—2011-12的75例（76髋）全髋关节翻修术,髋臼骨缺损根据Paprosky分型：Ⅰ型9髋,ⅡA型21髋,ⅡB型18髋,ⅡC型11髋,ⅢA型10髋,ⅢB型7髋。髋臼骨缺损采用不同方式修复,术后定期随访。采用髋关节功能Harris评分评估髋关节功能,根据X线片判断假体是否松动、植骨是否融合。结果 75例（76髋）均获得平均36（16~73）个月随访。术后12个月不同类型骨缺损患者髋关节功能Harris评分较术前明显提高,差异有统计学意义（P〈0.05）。术后症状和关节功能明显改善,未出现髋臼骨折、感染、下肢深静脉血栓形成、坐骨神经损伤等严重并发症。X线片可见移植骨与宿主骨质交界处有连续性骨小梁通过,假体未见松动迹象。结论髋臼假体无菌性松动及骨溶解是需要进行全髋关节翻修的主要原因,而髋臼骨缺损Paprosky分型法对髋臼翻修重建方法有指导意义,正确选择假体类型及合理选择植骨方式是全髋关节翻修术后取得满意疗效的保证。     

全髋关节翻修术髋臼骨缺损的处理体会

目的探讨全髋关节翻修术中对髋臼骨缺损的处理方法。方法收治并处理全髋关节翻修术中髋臼骨缺损患者36例,结合AAOS和CQAD分类对髋臼骨缺损进行分类评估,选择植骨方式和髋臼重建方式。结果所有患者术后Harris评分较术前具有显著性差异。结论全髋关节翻修术中的髋臼骨缺损结合AAOS和CQAD分型简单明确,有助于选择植骨方式和髋臼重建方式。     

A rare complication of ceramic-on-ceramic bearings in total hip arthroplasty

Each year, approximately 217000 primary total hip arthroplasties (THAs) are performed in the United States (National Center for Health Statistics, 2003). This number is expected to increase as our population ages, and the indication for THA expands to younger and more active patients. Efforts are continually being made to improve implant design and, ultimately, patient outcomes. One area in particular that has undergone tremendous change is bearing surface technology. Ceramic-on-ceramic technology has gained widespread popularity in young patients because of its improved wear characteristics and durability. Bearing surface advancement must be tempered with analysis of implant-specific complications. We report a case of an audible hip complication after the use of ceramic components in THA.     

Reinforcement rings in acetabular revisions: our trends

The authors, reviewing the international literature with their clinical experience developed in reconstructive surgery of acetabular defects due to aseptic loosening of acetabular cups, suggest their guidelines to the right use of acetabular reinforcement rings. Received: 8 September 2001/Accepted: 4 November 2001     

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.     

Squeaking after third-generation ceramic-on-ceramic total hip arthroplasty

We retrospectively reviewed records of 1002 patients who underwent a third-generation ceramic-on-ceramic total hip arthroplasty. Fifteen patients complained of squeaking, at any time after their arthroplasty. Of these 15 patients, 14 were evaluated clinically and radiologically. These 14 patients were found to have significantly higher mean body mass index of 25.8 kg/m(2) as compared with all the other patients who did not complain of squeaking (mean, 23.7 kg/m(2)) (P = .022). The acetabular opening angle was significantly lower (mean, 34°) than a matched control group (mean, 38°) (P = .016). Limb length shortening of more than 5 mm was observed in 12 (85.7%) of the 14 patients as compared with only 4 (28.6%) of 14 patients in the matched control group. Flexion and sitting cross legged were identified as the movements, which most commonly (11/12) resulted in squeaking. The incidence of squeaking was found to be low (1.5%), and we identified high body mass index, decreased acetabular opening angle, and limb length shortening as factors associated with squeaking.     

Removal of the acetabular component minimizing destruction of the bone bed

Removal of a well-fixed acetabular component can be difficult and may produce destruction of the acetabular bone bed. The authors describe a technique for removal of such a component with minimal bone destruction that involves the use of an offset punch and breaking the fixation interface in tension. This technique obviates the need for prying at the interface and fracturing the bone bed.     

Acetabular revision using a total acetabular allograft

The most challenging aspect of an acetabular revision is the management of severe bone loss, which compromises implant fixation and stability. We present a case of failed acetabular revision with extensive bone loss (Paprosky Type 3b) in a 50-year-old woman with rheumatoid arthritis, which was treated using total acetabular allograft. At a follow-up of 1 year and 3 months, the allograft had united with the host bone. This is the first report of the use of a total acetabular allograft for revision total hip arthroplasty in India. The total acetabular allograft allows the placement of the component closer to the normal hip center, provides initial stability for the acetabular component, and restores bone stock to the host pelvis.     

Catastrophic progression of the disassembly of a modular acetabular component

Disassembly of a metal-backed modular acetabular component used for total hip arthroplasty is becoming more common. If the acetabular disassembly is detected early, the revision procedures are relatively simple. In the case of long-term sustained disassembly, however, there are more complicated problems, and more difficult revision procedures are needed. We report a case of long-term sustained disassembly of a modular acetabular component in order to alert orthopaedic surgeons of the catastrophic progression to more severe complications, such as the loosening of the metal-acetabular component and severe acetabular osteolysis.     

Impaction grafting using a cemented porous-coated modular acetabular component

Reconstruction of major acetabular defects continues to challenge surgeons. There are many surgical options for these situations, including oversized hemispherical cups, oblong cups, acetabular cages, bulk allografts, and impaction allografting. We present the case of a modification to the impaction grafting technique for acetabular reconstruction. In our case, a porous-coated modular titanium acetabular component was cemented in place instead of an all-polyethylene acetabular component, which is the standard technique for impaction grafting reconstruction. The use of the modular component allowed a greater number of surgical options at the time of surgery. At 5 years from surgery, the patient has a successful reconstruction and the radiographs continue to look excellent.     

Screw-augmented fixation of acetabular components: A mechanical model to determine optimal screw placement

Sixteen embalmed hemipelves were used to determine the optimal acetabular screw placement to provide maximal screw pull-out strength in unicortical and bicortical screw fixation. The anterior column, superior ilium, posterior column, ischium, and pubis regions of the pelvis were tested using 6.5-mm titanium alloy screws and a hydraulic servo-controlled 1321 Instron testing machine. Force vs displacement data were acquired. Bicortical fixation was stronger than unicortical fixation in the four zones compared. This difference was significant in the superior ilium, posterior column, and ischium. The anterior column could not accept unicortical screws due to inadequate bone depth, which ranged between only 6 mm and 10 mm. Bicortical fixation was significantly greater in the superior ilium, posterior column, and ischium than in the anterior column or pubis. Unicortical fixation was greatest in the superior ilium. This information may aid decisions concerning the positioning of screws to augment acetabular component fixation.     

Cup-cage construct for massive acetabular defect in revision hip arthroplasty- A case series with medium to long-term follow-up

ObjectiveCup-cage reconstruction has emerged as a possible solution for managing massive acetabular defects with a few existing studies reporting encouraging results at mid-term follow-up. We present our experience with this unitised construct.MethodSix patients (7 hips) with a mean age of 76 years (73–81) were revised due to catastrophic aseptic failure of a primary cup implanted 10–19 years previously, having a Paprosky type 3B acetabular defect.ResultsAt a mean follow-up of 72 months (63–140) no cases have required re-revision. Oxford Hip Scores improved from an average of 8 (1–17) preoperatively to an average of 36 (18–45) at the last follow-up. WOMAC scores preoperatively averaged 76 (49–96) and postoperatively averaged 26.5 points (0–69) at the last follow-up. SF-12 scores improved in both components. One patient showed non-progressive osteolysis around the ischial flange and one had less than 5 mm migration of the construct. One patient died of unrelated causes.ConclusionOur study presents one of the longest follow-up of cup-cage construct and supports the previously reported good results; it encourages the use of this construct in reconstruction of massive acetabular defect, with or without pelvic discontinuity.