Padgett Douglas E, Kinkel Stefan
Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, 535 E 70 St, New York, NY 10021, USA.
Orthopedics. 2011 Sep 9;34(9):e482-4. doi: 10.3928/01477447-20110714-36.
Options in the management of the deficient femur during revision hip arthroplasty include cemented or cementless fixation. The results with cemented femoral revision have not been historically successful. While the use of extensively coated implants in revision total hip arthroplasty has been more uniformly excellent, issues, such as thigh pain, stress shielding, and lack of bone stock restoration, have been raised. Impaction grafting in revision hip arthroplasty is an attempt to reconstitute bone stock and avoid problems associated with excessively large or long uncemented stems. The original concept of impaction grafting was promoted by Slooff and applied to the femur by Gie and Ling. While originators' results were promising, issues, such as fracture and poor graft delivery, were noted. Modifications to the original technique were recently described by Howie, which used longer stems when necessary, as well as an improved graft delivery system. We report our results with 30 consecutive hips using this method. At follow-up, 3 patients were known to have died, leaving 27 for evaluation. Two of the 27 were failures: 1 recurrence of infection and 1 loose stem. The remaining 25 were clinical successes with bone stock restoration in all and no periprosthetic fractures. We believe that impaction grafting remains a viable option for the management of the severely deficient femur in whom cementless fixation methods are questionable.
髋关节翻修术中处理股骨骨量不足的方法包括骨水泥固定或非骨水泥固定。从历史上看，骨水泥型股骨翻修的效果并不理想。虽然在全髋关节翻修术中使用广泛涂层的植入物效果更为一致地出色，但也出现了诸如大腿疼痛、应力遮挡和骨量恢复不足等问题。髋关节翻修术中的打压植骨是为了重建骨量，并避免与过大或过长的非骨水泥柄相关的问题。打压植骨的最初概念由斯洛夫提出，吉和凌将其应用于股骨。虽然最初的结果很有希望，但也注意到了诸如骨折和植骨输送不佳等问题。豪伊最近描述了对原始技术的改进，必要时使用更长的柄以及改进的植骨输送系统。我们报告了连续30例使用该方法的髋关节的结果。在随访时，已知有3例患者死亡，剩下27例进行评估。27例中有2例失败：1例感染复发，1例柄松动。其余25例临床成功，所有患者骨量均得到恢复，且无假体周围骨折。我们认为，对于非骨水泥固定方法存疑的严重股骨骨量不足患者，打压植骨仍是一种可行的治疗选择。
