Barrack RL, Folgueras AJ
Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans.
J Am Acad Orthop Surg. 1995 Mar;3(2):79-85. doi: 10.5435/00124635-199503000-00003.
The initial results with cemented femoral revision stems were disappointing, with high early loosening rates. The application of second-generation cementing techniques improved results markedly, with loosening rates of 10% at 10 years in a number of series. Bone quality and patient age also appear to be important factors in predicting the success with a cemented revision stem. The use of a long stem is not necessary to obtain these improved results. On the basis of early reports, a recently described technique in which a revision stem is cemented into impacted cancellous allograft appears promising. Results with proximally coated uncemented revision stems have been variable, with failure rates of 4% to 10% reported at only 2 to 4 years. Initial stability must be obtained if proximal coating is to be utilized. Extensively coated revision stems provide initial stability through an interference fit between the porous coating and the diaphysis. With this technique, 10-year survival rates of 90% have been achieved, and the clinical results appear to be equivalent to those obtained with cemented revision stems and modern cementing techniques. Diaphyseal fixation has also been achieved without porous coating, either with modular revision stems or with long, textured titanium stems. Isolated early reports with such stems have been promising, but 10-year results are not yet available.
骨水泥型股骨翻修柄的早期结果令人失望，早期松动率很高。第二代骨水泥技术的应用显著改善了结果，在多个系列中10年时的松动率为10%。骨质量和患者年龄似乎也是预测骨水泥型翻修柄成功与否的重要因素。要获得这些改善的结果并不需要使用长柄。根据早期报告，最近描述的一种技术，即将翻修柄骨水泥固定于打压后的同种异体松质骨中，似乎很有前景。近端涂层非骨水泥型翻修柄的结果各不相同，据报道在仅2至4年时失败率为4%至10%。如果要使用近端涂层，必须获得初始稳定性。广泛涂层的翻修柄通过多孔涂层与骨干之间的压配提供初始稳定性。采用这种技术，已实现90%的10年生存率，而且临床结果似乎与使用骨水泥型翻修柄和现代骨水泥技术所获得的结果相当。无论是采用模块化翻修柄还是长的、有纹理的钛柄，也能在没有多孔涂层的情况下实现骨干固定。关于此类柄的早期单独报告很有前景，但尚无10年的结果。
