Gollwitzer H, von Eisenhart-Rothe R, Holzapfel B M, Gradinger R
Sektion Endoprothetik und rekonstruktive Hüft- und Kniegelenkschirurgie, Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, Munich, Germany.
Chirurg. 2010 Apr;81(4):284-92. doi: 10.1007/s00104-009-1845-2.
Approximately 18,000 hip revision procedures of the acetabular component are performed annually in Germany with rising incidence. The aims of acetabular revision are reconstruction of the anatomic hip center, reconstruction of bone stock, cement-free primary stability of the revision implant in autochthonous bone and permanent secondary integration.Precise planning of the revision surgery is necessary with analysis and classification of the bone defects and reconstruction following a concise therapeutic concept. Cup loosening without bone loss as well as segmental bone defects can usually be reconstructed with standard implants. Cavity defects, especially the common craniolateral defects, require the implantation of oval cups or augments to achieve anatomic reconstruction of the hip center. Combined segmental and cavity defects can be reconstructed using oval cups with craniolateral plates, whereas acetabular discontinuity requires stable fixation within the iliac wing by means of an intramedullary stem combined with an extramedullary plate. Middle and long term survival greater than 90% can be realized with the use of this therapeutic concept.
在德国,每年大约进行18,000例髋臼部件的髋关节翻修手术,且发病率呈上升趋势。髋臼翻修的目的是重建髋关节的解剖中心、恢复骨量、使翻修植入物在自体骨中实现无骨水泥的初始稳定性以及实现永久性的二期融合。翻修手术需要精确规划,包括对骨缺损进行分析和分类,并遵循简洁的治疗理念进行重建。无骨质丢失的髋臼杯松动以及节段性骨缺损通常可用标准植入物进行重建。腔隙性缺损,尤其是常见的颅外侧缺损,需要植入椭圆形髋臼杯或骨增量装置以实现髋关节中心的解剖重建。节段性和腔隙性联合缺损可用带颅外侧钢板的椭圆形髋臼杯进行重建,而髋臼连续性中断则需要通过髓内柄结合髓外钢板在髂骨翼内进行稳定固定。采用这种治疗理念可实现90%以上的中长期生存率。