Urschel C, Döring M, Strecker W
Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Klinikum am Bruderwald, Buger Straße 80, 96049, Bamberg, Deutschland,
Orthopade. 2014 Sep;43(9):815-24. doi: 10.1007/s00132-014-3003-x.
For fixation of total hip prostheses, cemented and cement-free techniques are available. Normally, anchoring techniques and the definitive endoprosthesis model are determined preoperatively based on the available information, such as the quality of bone. Some newer endoprosthesis models utilize the same instruments for both implantation techniques. In this way it is possible to decide on the final anchoring technique intraoperatively. Because such a combined endoprosthesis system has been used in our clinic for 10 years, we were interested in the clinical results at the intermediate stage.
In a prospective, non-randomized study 105 pairs from a continuing series were formed from 105 cases treated with cement-free prostheses and the latest cemented shaft implants from the same year. In this way a total of 210 hip shaft endoprostheses from the years 2002 to 2006 were included in the study. After an average time period of 6.3 years (range 4.5-8.2 years) the patients were recalled for a follow-up examination. The clinical results, early and late complications were analyzed. The immediately postoperative X-ray images and those from the follow-up examination were evaluated by an independent external expert with respect to primary positioning, migration and any signs of loosening.
At the follow-up examination at an average of 6.3 years the quota was 73%. The indications for cement-free/cemented total hip endoprosthesis were: primary arthritis 87%/98%, secondary arthritis 10%/2% and others 3%/0%. At the time of the last follow-up examination 4 and 14 patients, respectively, had died. The visual analog scale (VAS) for pain was given as 0.72/0.78. The Harris hip score improved from 54/48 to 93/90 points. The implant-related survival rate was 99.5%. Due to a periprosthetic fracture one of the cemented shafts had to be removed. Luxation occurred in 3/2 cases, respectively, of which 4 could be conservatively treated. In one cement-free case a head elongation and a change to an inlay with an anti-luxation shoulder was necessary. A fracture of the trochanter major was conservatively treated and an intraoperative shaft fissure was stabilized with wire cerclage and titan banding. The radiological evaluation showed no implant loosening or statistically significant differences in the shaft positioning.
Short and intermediate clinical and radiological results showed no differences in patients of similar average age in the sixth decade of life. The significant improvements in the Harris hip score and the range of movement could be confirmed in the intermediate term and are comparable to other current implants. It can be concluded that an intraoperative decision on the fixation technique based on the macroscopically visible bone quality supports the reliably good results of both methods.
对于全髋关节假体的固定，有骨水泥固定技术和无骨水泥技术可供选择。通常，术前会根据现有信息（如骨质质量）来确定固定技术和最终的假体模型。一些新型假体模型在两种植入技术中使用相同的器械。这样就有可能在术中决定最终的固定技术。由于这种组合式假体系统已在我们诊所使用了10年，我们对其中期临床结果感兴趣。
在一项前瞻性、非随机研究中，从105例接受无骨水泥假体治疗的患者以及同年最新的骨水泥柄植入物中组成了105对连续病例系列。这样，2002年至2006年期间共有210个髋关节柄假体纳入研究。平均随访6.3年（范围4.5 - 8.2年）后，召回患者进行随访检查。分析临床结果、早期和晚期并发症。由一名独立的外部专家对术后即刻的X线影像以及随访检查的影像进行评估，内容包括初始定位、移位以及任何松动迹象。
平均6.3年的随访检查时，随访率为�3%。无骨水泥/骨水泥全髋关节假体的适应证为：原发性关节炎87%/98%，继发性关节炎10%/2%，其他3%/0%。在最后一次随访检查时，分别有4例和14例患者死亡。疼痛的视觉模拟评分（VAS）为0.72/0.78。Harris髋关节评分从54/48分提高到93/90分。假体相关生存率为99.5%。由于假体周围骨折，不得不取出一个骨水泥柄。脱位分别发生在3/2例病例中，其中4例可保守治疗。在1例无骨水泥病例中，需要延长股骨头并更换为带有防脱位肩的镶嵌物。大转子骨折保守治疗，术中柄部裂隙用钢丝环扎和钛带固定。影像学评估显示没有假体松动，柄部定位也无统计学显著差异。
短期和中期的临床及影像学结果显示，在60岁左右平均年龄相似的患者中没有差异。Harris髋关节评分和活动范围的显著改善在中期得到证实，并且与其他当前的植入物相当。可以得出结论，基于肉眼可见的骨质质量在术中决定固定技术有助于两种方法都获得可靠的良好结果。
