Ten Have B L E F, Brouwer R W, van Biezen F C, Verhaar J A N
Martini Hospital Groningen, Orthopaedic Department, Van Swietenplein 1, Groningen 9728, The Netherlands.
J Bone Joint Surg Br. 2012 May;94(5):615-8. doi: 10.1302/0301-620X.94B5.27909.
The purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all, 21 hips (68%) had grade III or IV femoral defects according to the Endo-Klinik classification. A total of 11 patients (12 hips) died before the ten-year follow-up period. Of the remaining patients, 18 patients (19 hips) were followed for 10 to 15 years; three further patients died during this time. None of the 31 stems underwent further revision of their stem. However, four stems showed extensive subsidence (> 15 mm). One of these patients had a femoral fracture that required fixation. Three other patients had a femoral fracture, two of which required fixation and the other was treated conservatively. Patients with a femoral fracture and/or severe subsidence had significantly more grade IV defects (six of seven hips; p = 0.004). One patient needed a closed reduction for dislocation. Impaction allografting in revision hip surgery gives good long-term results for femora with grades I, II and III Endo-Klinik-classified defects. Extensive subsidence and femoral fractures were seen mainly in patients with grade IV damaged femora.
这项前瞻性研究的目的是评估采用打压植骨技术翻修全髋关节置换股骨部件的长期临床和影像学结果。对29例患者（31髋）进行了同种异体骨打压植骨的股骨翻修术。根据Endo-Klinik分类，共有21髋（68%）存在III级或IV级股骨缺损。共有11例患者（12髋）在十年随访期前死亡。在其余患者中，18例患者（19髋）接受了10至15年的随访；在此期间又有3例患者死亡。31个股骨柄均未进行进一步翻修。然而，有4个股骨柄出现了广泛下沉（>15 mm）。其中1例患者发生股骨骨折，需要进行固定。另外3例患者发生股骨骨折，其中2例需要固定，另1例采用保守治疗。发生股骨骨折和/或严重下沉的患者中，IV级缺损明显更多（7髋中有6髋；p = 0.004）。1例患者因脱位需要进行闭合复位。对于Endo-Klinik分类为I级、II级和III级缺损的股骨，在髋关节翻修手术中采用打压植骨可获得良好的长期效果。广泛下沉和股骨骨折主要见于IV级股骨损伤的患者。
