de Jong P T, van der Vis H M, de Man F H R, Marti R K
Department of Orthopedic Surgery Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Clin Orthop Relat Res. 2004 Feb(419):107-14.
Between 1974 and 1989, 315 primary total hip replacements (274 patients) were done using the cemented Weber Rotation prosthesis and standardized operative technique, which was modified for the stem in 1978. After the first postoperative year, all patients had routine clinical and radiologic examinations at 2-year intervals. Twenty-one patients (22 hips) were lost to followup. At the most recent followup, 30 of 293 hips (253 patients) had been revised: 24 hips for aseptic loosening, five hips for infection, and one hip for a femoral fracture. Survivorship analyses with revision for aseptic loosening as an end point for the 315 hips showed 93% and 78% survival after 10 and 15 years, respectively. Separate survival analyses for the socket showed 99% and 89% survival after 10 and 15 years, respectively. The stem had a survival of 94% and 81%, respectively, during the same time. Survival at 15 years with radiologic evidence of loosening as an end point was 85% for the socket and 72% for the stem. The cementing technique and the design of the acetabular component significantly influenced the rate of loosening. Survivorship analyses with revision for aseptic loosening of the socket, using a modified second generation cementing technique and a hemispheric socket, showed 100% survival after 10 years and 98% after 13 years.
1974年至1989年间,采用骨水泥固定的Weber旋转假体及标准化手术技术进行了315例初次全髋关节置换术(涉及274例患者),该技术于1978年对假体柄进行了改良。术后第一年之后,所有患者每两年进行常规临床和影像学检查。21例患者(22髋)失访。在最近一次随访时,293髋(253例患者)中有30髋进行了翻修:24髋因无菌性松动,5髋因感染,1髋因股骨骨折。以无菌性松动翻修为终点对315髋进行的生存分析显示,10年和15年后的生存率分别为93%和78%。对髋臼杯单独进行的生存分析显示,10年和15年后的生存率分别为99%和89%。同期假体柄的生存率分别为94%和81%。以有影像学证据的松动为终点,15年时髋臼杯的生存率为85%,假体柄为72%。骨水泥技术和髋臼组件的设计对松动率有显著影响。采用改良的第二代骨水泥技术和半球形髋臼杯,以髋臼杯无菌性松动翻修为终点进行的生存分析显示,10年后生存率为100%,13年后为98%。