Crawford S A, Siney P D, Wroblewski B M
The John Charnley Research Institute, Wrightington Hospital, Wigan, England, UK.
J Bone Joint Surg Br. 2000 Jul;82(5):684-8. doi: 10.1302/0301-620x.82b5.10685.
We have designed a modular cemented femoral component for revision of failed total hip arthroplasty in which deficiency of the proximal femur is such as to require a variable extrafemoral portion of the stem. We present the results of the first 74 operations in 72 patients; 56 of the patients had grade-3 or grade-4 femoral deficiency as defined by Gustilo and Pasternak and 24 had fractures of the proximal femur, of which 22 were periprosthetic. There was or had been infection in 19 hips. At a mean follow-up of 5 years 9 months (1 to 12 years) nine stems were radiologically loose of which three had been revised. There were no failures in 45 cases in which there was fixation of the distal stem of 10 cm or more. Dislocation occurred in nine patients and there were four cases of infection in the 19 which were, or had been, infected previously. There were no neurovascular complications and no intraoperative femoral fractures. The femoral bone stock improved radiologically in 45 hips of which 29 showed considerable reformation of the proximal femur; 27 remained unchanged and two showed increasing osteoporosis.
我们设计了一种模块化骨水泥型股骨假体，用于翻修失败的全髋关节置换术，其中股骨近端骨量不足，需要假体柄有可变的股外部分。我们展示了72例患者中前74例手术的结果；56例患者存在Gustilo和Pasternak定义的3级或4级股骨骨量不足，24例有股骨近端骨折，其中22例为假体周围骨折。19髋存在或曾有感染。平均随访5年9个月（1至12年），9个股骨柄在影像学上松动，其中3例已翻修。在45例远端柄固定10厘米或更长的病例中无失败发生。9例患者发生脱位，在19例曾有或现有感染的病例中有4例感染。无神经血管并发症，术中无股骨骨折。45髋的股骨骨量在影像学上有所改善，其中29髋显示股骨近端有明显重塑；27髋保持不变，2髋显示骨质疏松加重。
