股骨嵌压植骨的长期存活率是多少？
What is the long-term survival of impaction allografting of the femur?
出版信息
Clin Orthop Relat Res. 2013 Dec;471(12):3901-11. doi: 10.1007/s11999-013-2954-2.
BACKGROUND
Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures.
QUESTIONS/PURPOSES: We therefore asked what the survivorship of impaction bone grafting was at longer followup, if the severity of bone loss was associated with failure, and finally, if longer length stems had improved survival compared with shorter stems.
METHODS
Between 1993 and 2002, 78 femoral revisions were performed in 71 patients using impaction grafting. The average age of the patients was 67 years (range, 33–84 years). Sixty-nine of the 71 patients were available for followup evaluation. We obtained Harris hip scores preoperatively and postoperatively. Radiographs were measured for radiolucent lines. Patients were followed a minimum of 2 years (average, 10.6 years; range, 2-19 years).
RESULTS
Survival of the femoral component without revision for any cause was 93% (confidence interval [CI], 83%–97%) and for aseptic loosening was 98% (CI, 87%–100%) at 19 years. Neither severity of bone loss nor the length of the stem predicted failure.
CONCLUSIONS
Impaction bone grafting has a high survival of 93% at the 19-year followup for patients with severe bone loss of their femur.
背景
对于股骨有大量骨质流失的髋关节翻修手术，是具有挑战性的。我们此前报道了 41 例（44 髋）接受股骨打压植骨术治疗的患者，随访时间至少 2 年。以因症状性无菌性松动而再次手术作为终点，8 年时的生存率为 97%。然而，获得更长时间的生存数据对于充分比较这种手术技术与其他类型的髋关节翻修术至关重要。
问题/目的：因此，我们想知道在更长时间的随访中，打压植骨术的生存率是多少，如果骨量丢失的严重程度与失败有关，以及最终与短柄相比，长柄是否能提高生存率。
方法
1993 年至 2002 年，我们对 71 例患者的 78 例股骨翻修术采用了打压植骨术。患者的平均年龄为 67 岁（范围：33-84 岁）。71 例患者中有 69 例可进行随访评估。我们在术前和术后获得了 Harris 髋关节评分。对 X 线片进行了测量，以观察有无透亮线。患者的随访时间至少为 2 年（平均：10.6 年；范围：2-19 年）。
结果
在 19 年时，因任何原因而未行翻修的股骨生存率为 93%（置信区间 [CI]，83%-97%），无菌性松动的生存率为 98%（CI，87%-100%）。骨丢失的严重程度和柄的长度均不能预测失败。
结论
对于股骨严重骨质流失的患者，打压植骨术在 19 年的随访中具有 93%的高生存率。
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