基于 CT 的导航是否能提高陶瓷-陶瓷 THR 的长期生存率？
Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA?
机构信息
Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan.
出版信息
Clin Orthop Relat Res. 2012 Nov;470(11):3054-9. doi: 10.1007/s11999-012-2378-4.
BACKGROUND
Although navigated THA provides improved precision in implant positioning and alignment, it is unclear whether these translate into long-term implant survival.
QUESTIONS/PURPOSES: We compared survivorship, dislocation rate, and incidence of radiographic failures such as loosening and bearing breakage after THA with and without navigation at a minimum 10-year followup.
METHODS
We retrospectively reviewed 46 patients (60 hips) and 97 patients (120 hips) receiving THA with or without a CT-based navigation system, respectively, using cementless THA ceramic-on-ceramic bearing couples. There were no differences in age, sex, diagnosis, height, weight, BMI, or preoperative clinical score between groups. We evaluated survivorship, mode of acetabular and femoral component fixation, osteolysis, and implant wear or breakage at a minimum followup of 10 years (average, 11 years; range, 10-13 years).
RESULTS
Survival at 13 years was 100% with navigation and 95.6% (95% CI, 88.4%-98.4%) without navigation. With navigation, all cups were placed within a zone of 40° (range, 30°-50°) of radiographic inclination and 15° (range, 5°-15°) of radiographic anteversion; without navigation, 31 cups (26%) were placed outside this zone. Hips treated without navigation had a higher rate of dislocation (8%) than the navigated cases (0%). Revision was performed in four nonnavigated cases, all of which showed evidence of neck impingement on the ceramic liner. Moreover, seven other cases without navigation showed posterior neck erosion on radiographs. These 11 impingement-related mechanical complications correlated with cup malorientation, and the incidence of impingement-related complications was higher in nonnavigated cases.
CONCLUSIONS
Navigation reduced the rates of dislocation and impingement-related mechanical complications leading to revision in cementless THA using ceramic-on-ceramic bearing couples over a minimum 10-year followup.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
虽然导航 THA 可提高植入物定位和对准的精度，但尚不清楚这是否能转化为长期植入物存活率。
问题/目的：我们比较了在至少 10 年随访时，使用非骨水泥 THA 陶瓷对陶瓷承窝的情况下，行与不行导航 THA 的患者的存活率、脱位率以及松动和承窝破裂等放射学失败的发生率。
方法
我们回顾性分析了 46 例患者（60 髋）和 97 例患者（120 髋）分别接受了带或不带基于 CT 的导航系统的 THA，均使用非骨水泥 THA 陶瓷对陶瓷承窝。两组间在年龄、性别、诊断、身高、体重、BMI 或术前临床评分方面无差异。我们在至少 10 年（平均 11 年；范围 10-13 年）的随访时评估了存活率、髋臼和股骨部件固定方式、骨溶解以及植入物磨损或破裂情况。
结果
导航组 13 年的存活率为 100%，无导航组为 95.6%（95%CI，88.4%-98.4%）。使用导航时，所有髋臼杯均位于影像学倾斜 40°（范围 30°-50°）和前倾角 15°（范围 5°-15°）的范围内；无导航组 31 个髋臼杯（26%）超出了这个范围。未行导航的髋关节脱位率（8%）高于行导航的髋关节（0%）。非导航组中有 4 例进行了翻修，所有翻修患者均显示陶瓷衬里上有颈撞击的证据。此外，无导航组还有另外 7 例显示后侧颈骨侵蚀。这些与撞击相关的机械并发症与髋臼杯位置不良有关，且非导航组的撞击相关并发症发生率更高。
结论
在使用陶瓷对陶瓷承窝的非骨水泥 THA 中，导航可降低脱位率和与撞击相关的机械并发症发生率，从而减少翻修。
证据水平
III 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
Zotero 插件