采用锥形沟槽式股骨组配柄假体行股骨侧翻修

背景：组配式股骨柄翻修假体在理论上被认为能够克服骨水泥固定型股骨柄假体或生物学固定型非组配式股骨柄假体存在的各类缺点,一些文献也初步证实这类假体能取得更为满意的疗效。 目的：回顾性分析采用锥形沟槽式股骨组配柄假体行全髋股骨侧翻修的效果。 方法：2000-05/2005-08苏州大学附属第一医院收治全髋股骨侧翻修患者19例(21髋)。翻修前诊断均为股骨柄假体合并臼杯假体的无菌性松动。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14髋,Ⅲb缺损者3髋。全部患者的股骨侧翻修均采用利马锥形沟槽式股骨组配柄假体,股骨柄假体为钛合金制造。对翻修效果进行随访观察。 结果与结论：所有假体均获初始稳定,未发生感染、脱位等并发症。随访5~10年,末次随访Harris评分维持在(92.2±3.5)分。X射线片显示翻修柄获广泛骨长入达骨性稳定者20髋(95%),纤维性稳定者1髋(5%)。所有患者的近段骨缺损植骨区均显示广泛性骨修复。翻修柄在正、侧位X射线片上的髓内充填率分别达80%和70%以上者18髋(86%),< 80%和70%者3髋(14%),全组假体平均下沉2.4 mm。至今未见因假体松动或其他原因需行再翻修治疗患者。提示采用锥形沟槽式股骨组配柄假体行全髋股骨侧翻修,必须注重手动扩髓等方法预防骨折,合理的髓内充填和近段组件调整以预防假体下沉和脱位,以及锥形连接处近段的植骨重建等技术关键,才能取得更为满意的效果。

Total hip replacement revision with a fluted,tapered, modular stem

BACKGROUND:Modular femoral stem revision prosthesis is theoretically considered to overcome disadvantages of cemented femoral stem or biological fixed non-modular femoral stem. Some studies report favorable effect of modular femoral stem. OBJECTIVE:To summarize the experience on the revision total hip replacement with a fluted, tapered, modular stem. METHODS:From May 2000 to August 2005, 19 patients (21 hips) undergoing total femoral revision were selected from First Affiliated Hospital of Soochow University. All were diagnosed as aseptic loosening of stems coupled with bone loss prior to revision. Pre-revision femoral defects were classified according to the system of Paprosky, including 4 (19%) of type Ⅱ femoral bone loss, 14 (67%) of type Ⅲ a femoral bone loss, and 3 (14%) of type Ⅲ b femoral bone loss. The revision was performed using the fluted, tapered, modular stem. The revision effect was observed. RESULTS AND CONCLUSION:All stems achieved primary stability. No infection or dislocation was found. The Harris Hip Score at the latest follow-up maintained at 92.2±3.5. X-ray showed general bone ingrowth and bone stability in 20 hips (95%), and fiberous stability in 1 hip (5%). All of the cases showed bone restoration in the proximal defect zone after bone graft without increased radiolucent lines. Anterioposterior and lateral X-ray showed that femoral stem intramedullary filling rate was 80% and 70% in 18 hips (86%), < 80% and 70% in 3 hips (14%). All stems were in neutral position and the average subsidence was 2.4 mm. There were no re-revisions of the femoral stem for any reason. Revision with fluted, tapered, modular stem can achieve satisfied results. But we must pay more attention to the following factors: 1)Hand reaming was important to reduce fracture rate; 2)appropriate cannel filling and adjustment of proximal component can prevent subsidence and dislocation; 3)proximal cavity reconstruction around the Morse taper junction.