Nelissen Rob G H H, Valstar Edward R, Pöll Ruud G, Garling Eric H, Brand Ronald
Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
J Arthroplasty. 2002 Oct;17(7):826-33. doi: 10.1054/arth.2002.34532.
A prospective radiostereometric analysis (RSA) study of 18 patients with cemented revision hip surgery and impaction grafting with an Exeter stem was done with a follow-up of 2 years for all patients. All factors that could influence migration (ie, micromotion) of the stem were analyzed with a repeated measurements analysis of variance. Two groups could be identified: a stable group and a continuous migrating group. Two factors significantly influenced micromotion during the follow-up measurements. The first factor was the Paprosky classification (the bigger the defect, the higher the micromotion). The second factor was cement mantle defects in > or =1 Gruen zones. The migrating hip stems had more Gruen zones with cement mantle defects (45%) compared with the stable prostheses (21%). The effect of the first factor on micromotion was limited and probably clinically less relevant. Because the cement mantle defects found in this study were caused by poor instrumentation, the second factor stresses the importance of good instrumentation, which is essential to make this technically demanding technique effective in creating a stable stem-allograft construct in the defective femoral canal.
对18例行骨水泥型髋关节翻修手术并使用埃克塞特柄进行打压植骨的患者进行了一项前瞻性放射立体测量分析（RSA）研究，所有患者均随访2年。采用重复测量方差分析对所有可能影响柄迁移（即微动）的因素进行分析。可分为两组：稳定组和持续迁移组。在随访测量期间，有两个因素对微动有显著影响。第一个因素是帕罗斯基分类（骨缺损越大，微动越高）。第二个因素是在≥1个Gruen分区存在骨水泥壳缺损。与稳定假体（21%）相比，迁移的髋关节柄有更多存在骨水泥壳缺损的Gruen分区（45%）。第一个因素对微动的影响有限，可能在临床上相关性较小。由于本研究中发现的骨水泥壳缺损是由操作不当引起的，第二个因素强调了良好操作的重要性，这对于使这项技术要求较高的技术有效地在有缺陷的股骨髓腔内创建稳定的柄-异体骨结构至关重要。
