Drexler M, Abolghasemian M, Kuzyk P R, Dwyer T, Kosashvili Y, Backstein D, Gross A E, Safir O
Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
Bone Joint J. 2015 Aug;97-B(8):1050-5. doi: 10.1302/0301-620X.97B8.35641.
This study reports the clinical outcome of reconstruction of deficient abductor muscles following revision total hip arthroplasty (THA), using a fresh-frozen allograft of the extensor mechanism of the knee. A retrospective analysis was conducted of 11 consecutive patients with a severe limp because of abductor deficiency which was confirmed on MRI scans. The mean age of the patients (three men and eight women) was 66.7 years (52 to 84), with a mean follow-up of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild limp, and two had a persistent severe limp (p = 0.004). The mean power of the abductors improved on the Medical Research Council scale from 2.15 to 3.8 (p < 0.001). Pre-operatively, all patients required a stick or walking frame; post-operatively, four patients were able to walk without an aid. Overall, nine patients had severe or moderate pain pre-operatively; ten patients had no or mild pain post-operatively. At final review, the Harris hip score was good in five patients, fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively effective in the treatment of chronic abductor deficiency of the hip after THA when techniques such as local tissue transfer are not possible. Longer-term follow-up is necessary before the technique can be broadly applied.
本研究报告了在翻修全髋关节置换术（THA）后，使用新鲜冷冻的膝关节伸肌机制同种异体移植物重建外展肌缺损的临床结果。对11例因外展肌缺损导致严重跛行且经MRI扫描证实的连续患者进行了回顾性分析。患者平均年龄为66.7岁（52至84岁），其中男性3例，女性8例，平均随访33个月（24至41个月）。术后，2例患者无跛行，7例有轻度跛行，2例持续严重跛行（p = 0.004）。根据医学研究委员会量表，外展肌的平均力量从2.15提高到3.8（p < 0.001）。术前，所有患者都需要使用拐杖或助行架；术后，4例患者无需辅助就能行走。总体而言，9例患者术前有重度或中度疼痛；10例患者术后无疼痛或轻度疼痛。在最后一次复查时，5例患者的Harris髋关节评分良好，2例中等，4例较差。我们得出结论，当无法采用局部组织转移等技术时，使用伸肌机制同种异体移植物治疗THA后慢性髋关节外展肌缺损相对有效。在该技术能够广泛应用之前，需要进行更长时间的随访。
