Mikhail W E, Wretenberg P F, Weidenhielm L R, Mikhail M N
Department of Orthopaedic Surgery, Karolinska Hospital, S-171 76 Stockholm, Sweden.
Arch Orthop Trauma Surg. 1999;119(5-6):288-91. doi: 10.1007/s004020050412.
The aim of this study was to evaluate the results of complex hip revision using a cemented, collarless and polished femoral stem design (CPT, Zimmer, Warsaw, In.) within a tightly impacted morselized allograft. We have now been using the impaction grafting technique in combination with the CPT stem (Zimmer) for 10 years in complex cases of severe bone loss. In this study we have elected to report only those patients who have been revised at least once before revision using the impaction grafting technique. All the patients in the study group have a minimum follow-up of 5 years after the impaction grafting revision. In total, 43 consecutive hips in 40 patients, 22 men and 18 women, with a follow-up time of between 5 and 7 years are included in the study. The complications related to the revised hip consist of three early dislocations managed by closed reduction. Two patients suffered from periprosthetic fracture, both managed with plate osteosynthesis. Two cementless sockets were revised due to aseptic socket loosening. The Endoklinik rating of preoperative bone loss for the revised hips was 2 in 13 hips, 3 in 23 hips, and 4 in 7 hips. During the first year 29 stems subsided 2-4 mm within the cement mantle. In 8 cases, a subsidence of 5-9 mm was measured. The subsidence was nonprogressive, and no subsidence occurred after the 1st year. The Charnley, D'Aubigne, Postel scoring (maximum 6 points) for pain improved from 2.2 points preoperatively to 4.4 postoperatively, function from 2.3 to 4.3, and movement from 2.3 to 4.1. In conclusion, the concept of impaction grafting in THR revision in our study has so far proven to be successful with good clinical results at 5 years despite the relatively high early subsidence of the femoral component.
本研究的目的是评估在紧密嵌入的碎骨同种异体骨内使用骨水泥型、无领且表面抛光的股骨柄设计（CPT，捷迈公司，华沙，印第安纳州）进行复杂髋关节翻修的结果。在严重骨缺损的复杂病例中，我们使用嵌压植骨技术联合CPT股骨柄（捷迈公司）已达10年。在本研究中，我们选择仅报告那些在使用嵌压植骨技术进行翻修前至少已接受过一次翻修的患者。研究组所有患者在嵌压植骨翻修后至少随访5年。本研究共纳入40例患者的43例连续髋关节，其中男性22例，女性18例，随访时间为5至7年。与翻修髋关节相关的并发症包括3例早期脱位，通过闭合复位处理。2例患者发生假体周围骨折，均采用钢板内固定治疗。2例非骨水泥髋臼因无菌性髋臼松动而进行翻修。翻修髋关节术前骨量丢失的Endoklinik分级为：13例为2级，23例为3级，7例为4级。在第一年，29个股骨柄在骨水泥套内下沉2至4毫米。8例测量到下沉5至9毫米。下沉未进展，且在第1年后未再发生下沉。Charnley、D'Aubigne、Postel疼痛评分（满分6分）从术前的2.2分提高到术后的4.4分，功能评分从2.3分提高到4.3分，活动评分从2.3分提高到4.1分。总之，在我们的研究中，尽管股骨部件早期下沉相对较高，但在THR翻修中使用嵌压植骨的概念到目前为止已被证明是成功的，5年时临床效果良好。
