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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 567 -572. doi: 10.3877/cma.j.issn.1674-134X.2018.04.020

所属专题： 文献；

临床经验

生物型组配式锥形柄行全髋关节翻修术的中远期疗效
查俊俊1, 孙俊英2,†(), 王涛3, 王超2, 王雷2   
  1. 1. 225300　泰州市人民医院骨科；215006　苏州大学附属第一医院骨科
    2. 215006　苏州大学附属第一医院骨科
    3. 214000　无锡，江南大学附属医院骨科
  • 收稿日期:2017-10-12 出版日期:2018-08-01
  • 通信作者: 孙俊英

Mid to long-term results of total hip revision with cementless modular tapered stem

Junjun Zha1, Junying Sun2,†(), Tao Wang3, Chao Wang2, Lei Wang2   

  1. 1. Department of Orthopedic Surgery, Jiangsu Taizhou People’s Hospital, Taizhou 225300, China; Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    2. Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    3. Department of Orthopedic Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214000, China
  • Received:2017-10-12 Published:2018-08-01
  • Corresponding author: Junying Sun
  • About author:
    Corresponding author: Sun Junying, Email:
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引用本文：

查俊俊, 孙俊英, 王涛, 王超, 王雷. 生物型组配式锥形柄行全髋关节翻修术的中远期疗效[J]. 中华关节外科杂志(电子版), 2018, 12(04): 567-572.

Junjun Zha, Junying Sun, Tao Wang, Chao Wang, Lei Wang. Mid to long-term results of total hip revision with cementless modular tapered stem[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(04): 567-572.

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。

关键词: 关节成形术，置换，髋, 再手术, 假体设计
Objective

To evaluate medium and long term results of the revision total hip replacement with the cementless, modular, tapered stem.

Methods

From May 2000 to May 2011, the patients with tumors, prosthetic infections and follow-up for less than five years were excluded; 37 patients (39 hips) underwent total hip revision surgery with cementless modular tapered stem in the First Affiliated Hospital of Soochow University due to aseptic loosening and bone defect of femur. This study included 21 hips revised with the Lima (Lima-Lto, Udine, Italy) prosthesis and 18 hips revised with the Link MP (Waldemar Link, Hamburg, Germany) prosthesis. The time from primary total hip arthroplasty to revision was four to 15 years, (10.4±3.7) years on average. First revision was given in all the patients. Pre-revision diagnosis showed type IIIa (Paprosky classification) in 28 hips, type IIIb in 11 hips. All the bearing surfaces using ceramic-ceramic hip bearings. Harris scores were compared by t test, while the bone defection type was analysed by chi-square test.

Results

The mean follow-up time was (11.6±2.3) years (range, 6~16 years). Among the patients, 26 patients were evaluated at a minimum follow-up time of 10 years. There was no significant difference in femoral defect between two kinds of prosthesis revision (χ2=0.434; P>0.05). The Harris hip score was (43±10) preoperatively and maintain (90±3) at the latest follow-up (t=32.334; P<0.05). There was no statistical difference in the clinical effect between the two kinds of revision prostheses (t=0.881; P>0.05). The X-ray films showed bone ingrowths fixation in 38 hips (97.4%) and fibrous stable fixation in one hip (2.6%). The average stem subsidence was (2.1±2.3)mm(range, 0-10 mm). There was no re-revision of the femoral stem for any reason.

Conclusion

The mid-long term results of revision total hip replacement with the cementless, modular, tapered stem are encouraging in Paprosky type IIIa and IIIb femoral defect associated aseptic loosening of the femoral stem.

Key words: Arthroplasty, replacement, hip, Reoperation, Prosthesis design
图1 67岁男性右侧全髋关节置换术后8年假体无菌性松动行翻修术前后影像。图A　为术前右髋关节正位X线片，示Parprosky Ⅲb型骨缺损伴股骨柄假体松动；图B　为术后右髋关节正位片，示MP柄翻修＋颗粒骨填充植骨＋股骨大转子延长截骨＋钢板固定；图C　为右髋关节术后半年随访片，示原骨缺损植骨区骨密度增加，表明已获植骨重建；图D 　为右髋关节翻修术后11年的随访片，示假体无松动无下沉，假体周围无溶骨性骨缺损
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