THA 治疗髋臼前突时恢复髋关节中心与更好的假体生存率相关。
Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival.
机构信息
Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
出版信息
Clin Orthop Relat Res. 2013 Oct;471(10):3251-9. doi: 10.1007/s11999-013-3072-x. Epub 2013 May 24.
BACKGROUND
Acetabular protrusio is an uncommon finding in hip arthritis. Several reconstructive approaches have been used; however the best approach remains undefined.
QUESTIONS/PURPOSES: Our purposes in this study were to (1) describe the THA survivorship for protrusio as a function of the acetabular component, (2) evaluate survivorship of the cup as a function of restoration of radiographic hip mechanics and offset, and (3) report the long-term clinical results.
METHODS
One hundred twenty-seven patients (162 hips) undergoing primary THA with acetabular protrusio were retrospectively reviewed. The mean age of the patients at surgery was 66±13 years, and the mean followup was 10±6 years (range, 2-25 years).The cup fixation was uncemented in 107 (83 with bone graft) and cemented in 55 hips (14 with bone graft). Preoperative and postoperative radiographs were reviewed for restoration of hip mechanics and offset.
RESULTS
The THA survival from aseptic cup revision at 15 years was 89% (95% CI, 75%-96%) for uncemented compared with 85% (95% CI, 68%-94%) for cemented cups. The risk of aseptic cup revision significantly increased by 24% (hazards ratio, 1.24; 95% CI, 1.02-1.5) for every 1 mm medial or lateral distance away from the native hip center of rotation to the prosthetic head center. Harris hip scores were improved by mean of 27±20 points (n=123) with a higher postoperative score for uncemented bone grafted compared with solely cemented cups (81±16 versus 71±20 points).
CONCLUSIONS
Restoring hip center of rotation using an uncemented cup with or without bone graft was associated with increased durability in our series. There was a 24% increase in the risk of aseptic cup revision for every 1 mm medial or lateral distance away from the native hip center to the prosthetic head center.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
髋臼前突在髋关节关节炎中并不常见。已经使用了几种重建方法；然而，最佳方法仍未确定。
问题/目的：我们在这项研究中的目的是：(1)描述髋臼组件功能的前突性髋关节置换术的 THA 存活率，(2)评估髋臼杯作为放射学髋关节力学和偏移恢复功能的存活率，(3)报告长期临床结果。
方法
回顾性分析 127 例(162 髋)接受原发性 THA 伴髋臼前突的患者。患者手术时的平均年龄为 66±13 岁，平均随访时间为 10±6 年(范围，2-25 年)。107 髋采用非骨水泥固定(107 髋伴骨移植)，55 髋采用骨水泥固定(14 髋伴骨移植)。术前和术后 X 线片评估髋关节力学和偏移的恢复情况。
结果
15 年时，非骨水泥固定的 THA 存活率为 89%(95%CI，75%-96%)，骨水泥固定的 THA 存活率为 85%(95%CI，68%-94%)。髋臼头中心到假体头中心的每 1 毫米内侧或外侧距离偏离原有髋关节中心旋转的风险增加 24%(危险比，1.24；95%CI，1.02-1.5)。123 例中有 27±20 分的 Harris 髋关节评分得到改善，非骨水泥骨移植组的术后评分高于单纯骨水泥固定组(81±16 分比 71±20 分)。
结论
在我们的系列研究中，使用非骨水泥髋臼杯或联合使用骨移植来恢复髋关节中心旋转与增加耐用性相关。髋臼头中心到假体头中心的每 1 毫米内侧或外侧距离偏离原有髋关节中心的距离增加 1 毫米，无菌性髋臼杯翻修的风险增加 24%。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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