Toni A, Sudanese A, Ciaroni D, Dallari D, Greggi T, Giunti A
Cattedra di Patologia dell'Apparato Locomotore dell'Università di Bologna.
Chir Organi Mov. 1990 Jan-Mar;75(1):81-97.
The study reports the results obtained in 100 hips operated with a new cementless arthroplasty (AN.C.A.) characterized by the anatomical shape of a stem coated with Al2O3 and by a spherical acetabulum in ceramic-titanium, stabilized to the acetabulum first by screwing of the titanium ring and then by bony ingrowth in the cupola covered with porous ceramic. The patients were followed-up after an average of 17.4 months (+/- 8 SD). The patients were clinically evaluated using on the Merle d'Aubigné system, with the following average values +/- SD: pain 5.51 +/- 1, walking 5.01 +/- 1.1, and range of motion 5.38 +/- 0.9. The radiographic stabilization of the prosthesis (considering the worst results of the acetabulum and/or of the stem) was bony (BS) in 83% of the case and fibrous (FS) in 11%; 6 cases (5 acetabulums and 1 stem) showed signs of radiographic instability. Of these, 2 were submitted to further surgery to substitute the acetabulum. Two other patients were also submitted to a second operation: 1 involved substitution of the fractured ceramic head, and the other involved substitution of the stem in a patient with progressive coxalgia and no radiographic signs of loosening. The method of radiographic evaluation was significantly correlated with pain (p = 0.0001) and with walking (p = 0.0095). Instead, there were no significant correlations between stabilization of the prosthesis and precision of the femoral fit (press-fit) of the stem, age, evaluation of preoperative mineralization of the bone, and length of the stem. 8% of the cases presented important radiographic signs of stress-shielding; while 16% presented hypertrophy of the femoral cortex. These radiographic findings were not correlated to clinical ones.
该研究报告了采用一种新型非骨水泥关节成形术（AN.C.A.）对100例髋关节进行手术的结果。这种关节成形术的特点是，股骨柄呈解剖形状，表面涂有氧化铝，髋臼为陶瓷-钛材质的球形，首先通过拧紧钛环将其固定于髋臼，然后通过骨长入覆盖有多孔陶瓷的穹顶部分实现稳定。患者平均随访17.4个月（标准差±8）。采用Merle d'Aubigné系统对患者进行临床评估，得到以下平均值±标准差：疼痛5.51±1，行走能力5.01±1.1，活动范围5.38±0.9。假体的影像学稳定情况（考虑髋臼和/或股骨柄的最差结果）：83%为骨性稳定（BS），11%为纤维性稳定（FS）；6例（5个髋臼和1个股骨柄）显示有影像学不稳定迹象。其中，2例接受了进一步手术以置换髋臼。另外2例患者也接受了二次手术：1例是置换骨折的陶瓷股骨头，另1例是在一名患有进行性髋关节疼痛且无影像学松动迹象的患者中置换股骨柄。影像学评估方法与疼痛（p = 0.0001）和行走能力（p = 0.0095）显著相关。相反，假体稳定与股骨柄的股骨配合精度（压配）、年龄、术前骨矿化评估以及股骨柄长度之间无显著相关性。8%的病例出现了重要的应力遮挡影像学征象；而16%出现了股骨皮质肥大。这些影像学表现与临床情况无关。
