Kancherla Vamsi K, Del Gaizo Daniel J, Paprosky Wayne G, Sporer Scott M
Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
J Arthroplasty. 2014 Jan;29(1):210-3. doi: 10.1016/j.arth.2013.04.009. Epub 2013 May 10.
Powered trephines used over a femoral component to disrupt the bone component interface can yield acceptable clinical and radiographic outcomes while minimizing direct mechanical injury and indirect thermal necrosis. Thirty-six patients required trephining for fractured stems (16), infection (8), malposition (7), modular junction failure (4), and acetabular exposure (1). Harris Hip Scores (HHS), radiographic healing, and complications were assessed at a follow-up of 50.01 mo. Mean HHS increased from 46.61 preoperatively to 87.78 postoperatively (p<.0001). Two patients suffered spontaneous postoperative periprosthetic fractures in the region of the trephined bone at 3 mo and 4 mo postoperatively. Despite undergoing ORIF with locked plates, they both re-fractured with necrotic bone observed at the time of revision. There is a 5.6% incidence of femoral shaft fractures near the region of trephined bone within 1 year of surgery. Given the location of these fractures, thermal necrosis may have occurred and consideration should be given to distally bypassing the region of the femur that has been trephined.
使用动力环锯在股骨部件上操作以破坏骨部件界面，可产生可接受的临床和影像学结果，同时将直接机械损伤和间接热坏死降至最低。36例患者因股骨柄骨折（16例）、感染（8例）、位置不当（7例）、模块化连接失败（4例）和髋臼暴露（1例）需要进行环锯钻孔。在50.01个月的随访中评估了Harris髋关节评分（HHS）、影像学愈合情况和并发症。平均HHS从术前的46.61提高到术后的87.78（p<0.0001）。两名患者分别在术后3个月和4个月时，在环锯钻孔部位发生自发性假体周围骨折。尽管接受了锁定钢板切开复位内固定术，但他们在翻修时均再次骨折，并观察到坏死骨。手术1年内，环锯钻孔部位附近股骨干骨折的发生率为5.6%。鉴于这些骨折的位置，可能发生了热坏死，应考虑在股骨远端绕过已进行环锯钻孔的区域。
