Katz R L, Bourne R B, Rorabeck C H, McGee H
University Hospital, University of Western Ontario, London, Canada.
Clin Orthop Relat Res. 1992 Aug(281):145-51.
Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem.
31例髋关节缺血性坏死患者接受了34次全髋关节置换术（THA）。对所有患者进行前瞻性观察，至少随访两年（平均46个月；范围24 - 84个月）。20例采用当代骨水泥技术进行骨水泥型关节置换术。这包括插入髓内塞、用髓腔刷清理髓腔、脉冲冲洗以及用骨水泥枪注入骨水泥。14例髋关节使用了非骨水泥型假体。采用改良Harris髋关节评分对患者进行评估。对每位患者术后的系列X线片进行分析。骨水泥型组的总体Harris髋关节评分是88分，非骨水泥型组是84分。1例发生深部脓毒症的患者出现股骨部件松动的机械性失败。非骨水泥型组有4例患者出现明显的大腿疼痛。文献中先前的研究普遍报道，接受THA治疗的髋关节缺血性坏死患者预后不佳。采用当代骨水泥技术的非骨水泥型和骨水泥型固定方式，有望取得更好的结果。非骨水泥型组大腿疼痛的高发生率（29%）仍然是一个问题。
