GAP II 环与受影响的同种异体骨移植物在严重髋臼缺损中的高失败率。
High failure rate with the GAP II ring and impacted allograft bone in severe acetabular defects.
机构信息
Hip Surgery Unit, Institute of Orthopaedics Carlos E Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
出版信息
Clin Orthop Relat Res. 2012 Nov;470(11):3148-55. doi: 10.1007/s11999-012-2402-8.
BACKGROUND
Reconstruction rings and bone allografts have been proposed to manage severe acetabular bone loss. However, a high early failure rate of the Graft Augmentation Prosthesis (GAP) II reinforcement ring (Stryker Orthopaedics, Mahwah, NJ, USA) has been reported in one small series.
QUESTIONS/PURPOSES: We therefore determined (1) the survival of this device in combination with impacted morselized allograft bone in patients with severe defects and (2) the complication rate.
METHODS
We retrospectively reviewed 24 patients (21 aseptic and three septic) with severe acetabular bone loss (10 hips with Type III defects and 14 with Type IV defects according to the American Academy of Orthopaedic Surgeons classification). We determined function and numbers of failures. The minimum followup was 24 months (mean, 34 months; range, 24-72 months).
RESULTS
At latest followup, the reconstruction had failed in nine of the 24 patients: six with aseptic loosening, three with infection. The average postoperative Merle d'Aubigné-Postel score of the patients whose reconstructions had not failed was 16.6 points; at latest followup, these patients had radiographic evidence of incorporation and consolidation of bone allografts. Seven of the nine patients whose reconstructions had failed underwent reoperation. Fatigue fracture of the ring at the plate-cup union occurred in five patients at an average of 45 months postoperatively. All patients with failed reconstructions who underwent reoperation were treated with Trabecular Metal(™) (Zimmer Inc, Warsaw, IN, USA) cups and were functioning well at latest followup.
CONCLUSIONS
We observed a high rate (37%) of early catastrophic failures of the GAP II reconstruction ring, particularly in patients with Type IV defects. Due to this high failure rate, we have abandoned its use.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
重建环和同种异体骨移植已被提议用于治疗严重的髋臼骨缺损。然而，在一个小系列中报道了 Stryker Orthopaedics（新泽西州 Mahwah）的 Graft Augmentation Prosthesis（GAP）II 加强环的早期高失败率。
问题/目的：因此，我们确定了（1）在有严重缺陷的患者中，该装置与冲击碎同种异体骨移植骨结合的存活率，以及（2）并发症发生率。
方法
我们回顾性分析了 24 例（21 例无菌性和 3 例感染性）严重髋臼骨缺损患者（根据美国矫形外科医师学会分类，10 髋为 III 型缺损，14 髋为 IV 型缺损）。我们确定了功能和失败的数量。最低随访时间为 24 个月（平均 34 个月；范围 24-72 个月）。
结果
在最后一次随访时，24 例患者中有 9 例重建失败：6 例无菌性松动，3 例感染。重建未失败患者的平均术后 Merle d'Aubigné-Postel 评分为 16.6 分；在最后一次随访时，这些患者的影像学显示同种异体骨移植的融合和整合。重建失败的 9 例患者中有 7 例接受了再次手术。在术后平均 45 个月时，有 5 例患者发生环在板杯连接处的疲劳骨折。所有重建失败并接受再次手术的患者均采用 Trabecular Metal（Zimmer Inc，印第安纳州 Warsaw）杯治疗，在最后一次随访时功能良好。
结论
我们观察到 GAP II 重建环的早期灾难性失败率很高（37%），尤其是在 IV 型缺损患者中。由于这种高失败率，我们已放弃使用该装置。
证据水平
IV 级，治疗研究。有关证据水平的完整描述，请参见作者说明。
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