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[使用 Müller 直柄假体(骨水泥型 TiAlNb 柄)进行全髋关节置换术后 5 至 8 年的结果]

[5- to 8-year results of total hip endoprosthesis implantation with the Müller straight shaft prosthesis (cemented TiAlNb shaft)].

作者信息

Rader C P, Hendrich C, Löw S, Walther M, Eulert J

机构信息

Orthopädische Universitätsklinik Würzburg.

出版信息

Unfallchirurg. 2000 Oct;103(10):846-52. doi: 10.1007/s001130050631.

Abstract

The aim of this study was to obtain mid-term results after total hip arthroplasty (THA) with cemented titanium stems. In all, 184 patients with a total of 202 THAs (cemented titanium stem) were clinically and radiologically examined after an average follow-up of 6 years (5-8). The recruitment was 86%. The Harris score was determined clinically. Radiologically, the directly postoperative radiographs were compared to the control radiographs according to the recommendations of Gruen et al. and Johnston et al. In 2 cases (1%) septical complications appeared after 2 years, which were treated in two-stage surgery. To date, revisions after loosening have been carried out in 3 cases (1.5%). This is equivalent to a revision rate of 2.5%. Three further cases showed evidence of loosening in more than 5 radiolucent lines (RLL), according to Gruen, making close-meshed controls necessary. Clinically, in all of the 6 cases of aseptic loosening, the Harris score remained above 80 points. In 36 cases, more than one RLL, compared to the postoperative radiographs, was ascertained and mainly found in zones 1, 7, 8, and 14. Substantial subsidence or varus could only be observed in one case. The clinical results in the Harris score were good or excellent in 78% and satisfactory in 20%. With an average of 75 at the time of follow-up, the age of the patients was, according to the indication that only patients above age 60 are to receive cemented-stem prostheses, clearly advanced. The body weight was significantly higher (82 kg; d = 2.4) in those 6 patients having evident RLL, than in patients without RLL. The ratio body weight to surface of the stem was especially different (1.5 kg/cm2 versus 1 kg/cm2; P < 0.005) in the two groups. This did not apply to sex or activity of the patient, size or kind of stem, Harris score, ectopic ossification, or body weight index. The biggest possible stem should be implanted. Not all cemented titanium stem prostheses are necessarily affected with a high rate of loosening at a mid-term follow-up.

摘要

本研究的目的是获得使用骨水泥型钛柄全髋关节置换术(THA)后的中期结果。总共184例患者接受了202次全髋关节置换术(骨水泥型钛柄),平均随访6年(5 - 8年)后进行了临床和放射学检查。招募率为86%。通过临床确定Harris评分。放射学方面,根据Gruen等人和Johnston等人的建议,将术后即刻的X线片与对照X线片进行比较。2例(1%)患者在2年后出现感染性并发症,通过两阶段手术进行了治疗。迄今为止,因松动进行翻修的有3例(1.5%)。这相当于翻修率为2.5%。另外3例根据Gruen标准显示有超过5条透亮线(RLL),表明有松动迹象,因此需要密切随访。临床上,在所有6例无菌性松动病例中,Harris评分均保持在80分以上。与术后X线片相比,36例患者出现了不止一条RLL,主要出现在1区、7区、8区和14区。仅在1例中观察到明显的下沉或内翻。Harris评分的临床结果为78%良好或优秀,20%满意。根据仅对60岁以上患者使用骨水泥柄假体的指征,随访时患者平均年龄为75岁,明显偏大。6例有明显RLL的患者体重显著高于无RLL的患者(82千克;差值 = 2.4)。两组患者的体重与柄表面积之比差异尤为明显(1.5千克/平方厘米对1千克/平方厘米;P < 0.005)。这与患者的性别、活动情况、柄的尺寸或类型、Harris评分、异位骨化或体重指数无关。应植入尽可能大的柄。并非所有骨水泥型钛柄假体在中期随访时都会有高松动率。

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