使用骨水泥固定双动式关节窝治疗复发性脱位。
The use of a cemented dual mobility socket to treat recurrent dislocation.
机构信息
The Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, Université René Descartes, Hôpital Cochin (AP-HP), 75014, Paris, France.
出版信息
Clin Orthop Relat Res. 2010 Dec;468(12):3248-54. doi: 10.1007/s11999-010-1404-7.
BACKGROUND
The treatment of recurrent dislocation after total hip arthroplasty remains challenging. Dual mobility sockets have been associated with a low rate of dislocation but it is not known whether they are useful for treating recurrent dislocation.
QUESTIONS/PURPOSES: We therefore asked whether a cemented dual mobility socket would (1) restore hip stability following recurrent dislocation; (2) provide a pain-free and mobile hip; and (3) show durable radiographic fixation.
METHODS
We retrospectively reviewed 51 patients treated with a cemented dual mobility socket for recurrent dislocation after total hip arthroplasty between August 2002 and June 2005. The mean age at the time of the index procedure of was 71.3 years. Of the 51 patients, 47 have had complete clinical and radiographic evaluation data at a mean followup of 51.4 months (range, 25-76.3 months).
RESULTS
The cemented dual mobility socket restored complete stability of the hip in 45 of the 47 patients (96%). The mean Merle d'Aubigné hip score was 16 ± 2 at the latest followup. Radiographic analysis revealed no or radiolucent lines less than 1 mm thick located in a single acetabular zone in 43 of 47 hips (91.5%). The cumulative survival rate of the acetabular component at 72 months using revision for dislocation and/or mechanical failure as the end point was 96% ± 4% (95% confidence interval, 90%-100%).
CONCLUSIONS
A cemented dual mobility socket was able to restore hip stability in 96% of recurrent dislocating hips. However, longer-term followup is needed to ensure that dislocation and loosening rates will not increase.
背景
全髋关节置换术后复发性脱位的治疗仍然具有挑战性。双动式髋臼假体与脱位率低有关,但尚不清楚其是否对复发性脱位有用。
问题/目的:因此,我们想知道,(1)水泥固定的双动式髋臼假体能否在全髋关节置换术后复发性脱位后恢复髋关节稳定性;(2)能否提供无痛和活动的髋关节;(3)能否显示出持久的影像学固定。
方法
我们回顾性分析了 2002 年 8 月至 2005 年 6 月期间因全髋关节置换术后复发性脱位而接受水泥固定双动式髋臼假体治疗的 51 例患者。索引手术时的平均年龄为 71.3 岁。在平均 51.4 个月(25-76.3 个月)的随访中,有 47 例患者具有完整的临床和影像学评估数据。
结果
在 47 例患者中,水泥固定的双动式髋臼假体使 45 例(96%)患者髋关节完全稳定。末次随访时,Merle d'Aubigné 髋关节评分平均为 16 ± 2。影像学分析显示,47 髋中有 43 髋(91.5%)存在无或不超过 1 毫米厚的透亮线,仅位于单个髋臼区。以翻修为脱位和/或机械失败为终点,髋臼组件的 72 个月累积生存率为 96% ± 4%(95%置信区间,90%-100%)。
结论
水泥固定的双动式髋臼假体能够使 96%的复发性脱位髋关节恢复稳定性。然而,需要更长时间的随访以确保脱位和松动率不会增加。