Babis G C, Sakellariou V I, O'Connor M I, Hanssen A D, Sim F H
First Department of Orthopaedics, University of Athens, Attikon University General Hospital, 1 Rimini Street, Chaidari, Attica, Greece.
J Bone Joint Surg Br. 2010 Mar;92(3):349-55. doi: 10.1302/0301-620X.92B3.23112.
We report the use of an allograft prosthetic composite for reconstruction of the skeletal defect in complex revision total hip replacement for severe proximal femoral bone loss. Between 1986 and 1999, 72 patients (20 men, 52 women) with a mean age of 59.9 years (38 to 78) underwent reconstruction using this technique. At a mean follow-up of 12 years (8 to 20) 57 patients were alive, 14 had died and one was lost to follow-up. Further revision was performed in 19 hips at a mean of 44.5 months (11 to 153) post-operatively. Causes of failure were aseptic loosening in four, allograft resorption in three, allograft nonunion in two, allograft fracture in four, fracture of the stem in one, and deep infection in five. The survivorship of the allograft-prosthesis composite at ten years was 69.0% (95% confidence interval 67.7 to 70.3) with 26 patients remaining at risk. Survivorship was statistically significantly affected by the severity of the pre-operative bone loss (Paprosky type IV; p = 0.019), the number of previous hip revisions exceeding two (p = 0.047), and the length of the allograft used (p = 0.005).
我们报告了在严重股骨近端骨丢失的复杂翻修全髋关节置换术中使用同种异体移植假体复合物重建骨骼缺损的情况。1986年至1999年间，72例患者（20例男性，52例女性）平均年龄59.9岁（38至78岁）接受了此项技术重建。平均随访12年（8至20年），57例患者存活，14例死亡，1例失访。术后平均44.5个月（11至153个月），19髋进行了再次翻修。失败原因包括4例无菌性松动、3例同种异体骨吸收、2例同种异体骨不愈合、4例同种异体骨骨折、1例柄部骨折及5例深部感染。同种异体移植假体复合物10年生存率为69.0%（95%可信区间67.7至70.3），26例患者仍有风险。术前骨丢失的严重程度（Paprosky IV型；p = 0.019）、既往髋关节翻修次数超过2次（p = 0.047）以及所用同种异体骨的长度（p = 0.005）对生存率有统计学显著影响。
