Ilchmann Thomas, Gelzer Jan Philipp, Winter Eugen, Weise Kuno
Department of Orthopedics, Kantonsspital Liestal, Switzerland.
Acta Orthop. 2006 Feb;77(1):79-86. doi: 10.1080/17453670610045722.
Reconstruction of the bone stock and fixation of the implant remain challenging problems in revision surgery. In this retrospective study, we wanted to gain information on initial stability and wear after revision with the Burch-Schneider ring.
Between 1994 and 1998, we performed 70 reconstructions of the acetabulum with a Burch-Schneider ring in revision arthroplasty. 63 patients could be followed up clinically and radiographically. 40 cups were suitable for EBRA measurements whereas migration and wear could not be assessed by this method in 23 cases due to lack of comparability of pelvic radiographs. The mean follow-up time was 4.7 years.
2 cups were re-revised and 14 cups had breakage or changes of position of the screws. 30 cups showed detectable migration and 18 cups detectable wear. The mean migration was 2.8 mm and the mean wear rate was 0.12 mm/year. 16 cups had detectable migration after 1 year; 11 of these 16 continued to migrate and 9 of them had screw breakage. Both re-revisions showed early migration. Early migration correlated with later screw breakage and the overall migration correlated with wear. The only risk factor found for early migration was the wear rate.
The Burch-Schneider ring is an established and reliable implant for cup revision with good clinical results, but it seems to be difficult to maintain intraoperative stability. The implants with continuous migration may lead to late clinical failure and require further observation. Wear may contribute to migration and resorption of the bone graft.
在翻修手术中，骨量重建和植入物固定仍然是具有挑战性的问题。在这项回顾性研究中，我们希望获取有关使用Burch-Schneider环进行翻修后的初始稳定性和磨损情况的信息。
1994年至1998年间，我们在翻修关节成形术中用Burch-Schneider环对70例髋臼进行了重建。63例患者接受了临床和影像学随访。40个髋臼杯适合进行EBRA测量，而23例因骨盆X线片缺乏可比性，无法用该方法评估移位和磨损情况。平均随访时间为4.7年。
2个髋臼杯再次翻修，14个髋臼杯出现螺钉断裂或位置改变。30个髋臼杯有可检测到的移位，18个髋臼杯有可检测到的磨损。平均移位为2.8mm，平均磨损率为0.12mm/年。16个髋臼杯在1年后有可检测到的移位；这16个中的11个继续移位，其中9个出现螺钉断裂。两次再次翻修均显示早期移位。早期移位与后期螺钉断裂相关，总体移位与磨损相关。发现的早期移位的唯一危险因素是磨损率。
Burch-Schneider环是一种成熟且可靠的髋臼杯翻修植入物，临床效果良好，但术中似乎难以维持稳定性。持续移位的植入物可能导致晚期临床失败，需要进一步观察。磨损可能导致骨移植的移位和吸收。
