Sewell Mathew D, Hanna Sammy A, Carrington Richard W, Pollock Robin C, Skinner John A, Cannon Stephen R, Briggs Timothy W R
Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
Acta Orthop Belg. 2010 Aug;76(4):493-502.
Addressing severe proximal femoral bone loss in revision hip surgery is a challenging reconstructive problem. The use of modular proximal femoral megaprostheses is one of many available options to address this. This is a retrospective review of 15 patients who had undergone limb salvage at our institution using a modular proximal femoral replacement. There were 8 males and 7 females with a mean age of 67 years (34 to 85) and a mean follow-up of 60 months (1 to 99). Indications included re-implantation for deep infection in nine patients, aseptic loosening in three, periprosthetic fracture in two and painful excision arthroplasty in one. Mean Harris hip score increased from 28 (13 to 49) pre-operatively to 69 (39 to 85) at final follow-up (paired t-test, p < 0.0001) and mean Toronto Extremity Salvage score increased from 26% (14 to 40) to 71% (35 to 82) (paired t-test, p < 0.0001). Prosthesis survival with revision as the endpoint was 87% at 5 years. There were two dislocations (14%) and there was failure to eradicate deep infection in two. Modular proximal femoral replacement provided good function and versatility with an acceptable complication rate for patients with severe proximal femoral bone loss with or without infection.
解决翻修髋关节手术中严重的股骨近端骨丢失是一个具有挑战性的重建问题。使用模块化股骨近端假体是解决这一问题的众多可用选择之一。这是一项对15例在我们机构接受模块化股骨近端置换保肢手术患者的回顾性研究。其中男性8例，女性7例，平均年龄67岁（34至85岁），平均随访60个月（1至99个月）。手术指征包括9例因深部感染进行再植入、3例无菌性松动、2例假体周围骨折和1例疼痛性关节切除成形术。Harris髋关节平均评分从术前的28分（13至49分）提高到末次随访时的69分（39至85分）（配对t检验，p<0.0001），多伦多肢体挽救平均评分从26%（14至40）提高到71%（35至82）（配对t检验，p<0.0001）。以翻修为终点的假体5年生存率为87%。发生2例脱位（14%），2例深部感染未得到根除。对于有或无感染的严重股骨近端骨丢失患者，模块化股骨近端置换提供了良好的功能和通用性，并发症发生率可接受。
