评价非组配式带棘锥形长柄在髋关节翻修股骨重建中的疗效。

对2010年1月至2015年1月间，在武汉大学人民医院骨关节外科使用非组配式带棘锥形长柄行髋翻修的61例患者临床及影响学资料进行回顾性分析，其中男36例，女25例；年龄平均(61±7)岁。根据骨盆平片及患髋侧位X线片观察髋臼、股骨假体的位置及其周围骨质变化。采用配对t检验对术前术后的疼痛视觉模拟评分(VAS)和Harris髋关节评分进行比较。

所有患者均获2年以上随访，平均(5.6±2.2)年。随访期间，无假体周围感染和假体松动发生。1例术后2周脱位，经手法复位后未复发。1例术后2年发生假体周围骨折，行骨折内固定处理。与术前相比，术后1个月(t＝10.5505，P ＝0.000)、3个月(t＝12.6154，P <0.05)和6个月(t＝16.6196，P <0.05)VAS评分较术前明显改善；Harris评分均明显高于对照组(术后1个月t＝14.1128，P <0.05；术后3个月t＝30.0689，P <0.05；术后6个月t＝59.9639，P <0.05)。末次随访时Harris评分优45例，良10例，可6例，优良率为90.2%。末次随访时股骨柄假体的位置无明显改变，中心固定有58髋(95.1%)，柄－髓腔匹配优良率100%。所有病例均出现股骨近端骨重塑，其中Ⅰ度56髋，Ⅱ度5髋。

在股骨假体周围骨折(Vancouver B2 、Vancouver B3)和股骨近端骨缺损(Parprosky Ⅱ、Parprosky Ⅲ)病例中，采用非组配式带棘锥形长柄假体行股骨侧翻修疗效满意，具有操作简便、骨长入良好等特点。

To evaluate the efficacy of Wagner self-locking stem (Wagner SL) in femoral revision.

Sixty-one hip revision cases using Wagner SL revision stems in Renmin Hospital of Wuhan University were retrospectively analyzed. These cases included 36 males, 25 females; mean age of (61±7) years. The visual analogue scale (VAS) and Harris hip score system was used to evaluate the clinical efficacy. The position of the acetabulum and femoral prostheses and the changes of bone around them were observed according to the pelvic plain film and the positive and lateral X-ray of the hip. The visual analogue scale(VAS)and Harris hip score were adopted for evaluation and analyzed by paired t test.

All the patients were followed up for (5.6±2.2) years. During the follow-up, no infection around the prosthesis and loosening of the prosthesis occurred. One patient had dislocation two weeks after the surgery and did not relapse after manual reduction. One patient had a periprosthetic fracture two years after the operation and was treated with open reduction and internal fixation. Compared to the preoperative score, the VAS(one month after surgery t=10.5505, P<0.01; three months after surgery t=12.6154, P <0.05; six months after surgery t=16.6196, P <0.05)and Harris scores(one month after surgery t=14.1128, P <0.05; three months after surgery t=30.0689, P <0.05; six months after surgery t=59.9639, P <0.05) were greatly improved at the three follow-up time points, and the differences were significant. At the last follow-up, the Harris scores were excellent in 45 cases; good in 10 cases; fair in six cases; the excellent and good rate was 90.2%. At the last follow-up, there was no significant change in the position of the femoral stem prosthesis. Bone remodeling around the stem of the proximal femur could be seen in all the cases, among which 56 cases were degree Ⅰ, five cases were degree II .

For the patients with femoral periprosthetic fractures (Vancouver B2, Vancouver B3) and proximal femoral bone defects (Parprosky II, Parprosky Ⅲ), the Wagner SL revision stem is a good choice, which is easy to use and has been proved to be reliable in enabling restoration of the bone stock, and the clinical effcacy is satisfactory.