Schreurs B Willem, Thien Truike M, de Waal Malefijt Maarten C, Buma Pieter, Veth René P H, Slooff Tom J J H
Department of Orthopaedic Surgery, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
J Bone Joint Surg Am. 2003 Apr;85(4):647-52. doi: 10.2106/00004623-200304000-00010.
Acetabular revision in patients with rheumatoid arthritis is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup.
Thirty-five consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with rheumatoid arthritis. The average age at the revision was fifty-seven years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 7.5 years; range, three to fourteen years). No patient was lost to follow-up, but five patients (six hips) died before the time of the review. The acetabular bone defects were classified as cavitary in twelve hips and as combined segmental-cavitary in twenty-three.
The five patients (six hips) who died had been doing well at the time of their latest follow-up. Of the remaining patients, six (six hips) had a repeat revision. The average Harris hip score of the living patients with a surviving implant at the time of follow-up was 82 points, and there was no or only mild pain in twenty-one of the twenty-three hips. Radiographic analysis of all twenty-nine hips that had not been revised showed loosening in one hip and a nonprogressive radiolucent line in one zone in two others. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 90% at eight years.
Acetabular revision with impaction bone-grafting and a cemented cup in patients with rheumatoid arthritis had acceptable results at an average of 7.5 years postoperatively.
由于髋臼骨量和质量较差，类风湿关节炎患者的髋臼翻修手术通常很困难。本研究的目的是评估采用打压植骨技术和骨水泥聚乙烯杯进行髋臼翻修的中期临床和影像学结果。
对28例类风湿关节炎患者连续进行了35次髋臼翻修手术，采用打压植骨技术并使用骨水泥杯。翻修时的平均年龄为57岁。所有仍在使用或随访至死亡的重建手术的最短随访时间为3年（平均7.5年；范围3至14年）。没有患者失访，但有5例患者（6髋）在复查前死亡。髋臼骨缺损在12髋中被分类为空穴型，在23髋中被分类为节段 - 空穴复合型。
死亡的5例患者（6髋）在最后一次随访时情况良好。其余患者中，6例（6髋）进行了再次翻修。随访时存活植入物的存活患者的平均Harris髋关节评分为82分，23髋中有21髋无疼痛或仅有轻微疼痛。对所有29例未翻修的髋关节进行影像学分析，发现1髋松动，另外2髋在一个区域有非进展性透亮线。Kaplan-Meier分析显示，以无菌性松动为终点，8年时假体生存率为90%。
类风湿关节炎患者采用打压植骨技术和骨水泥杯进行髋臼翻修，术后平均7.5年取得了可接受的结果。
