Baba Tomonori, Homma Yasuhiro, Ochi Hidenori, Ozaki Yu, Matsumoto Mikio, Shitoto Katsuo, Kaneko Kazuo
Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Orthopedic Surgery, Juntendo Urayasu Hospital, Chiba, Japan.
Eur J Orthop Surg Traumatol. 2016 Feb;26(2):189-94. doi: 10.1007/s00590-015-1738-7. Epub 2016 Jan 11.
Clinical outcomes of total hip arthroplasty (THA) to treat rapidly destructive coxarthrosis (RDC) have been reported, but to our knowledge, there have been no studies comparing implants. The aim of this study was to examine the effectiveness of acetabular reconstruction for RDC by comparing the clinical results of THA using a Kerboull-type plate with an uncemented cup.
Among 921 primary THAs performed between 2006 and 2014, 27 were performed for the treatment for RDC using a Kerboull-type plate or a conventional uncemented cup. A Kerboull-type plate for acetabular reinforcement device was used in 13 hips and an uncemented cup in 14 hips. The mean follow-up period was 61.2 months.
The duration of surgery was 156.8 ± 36.4 min in the Kerboull-type plate group and 103.3 ± 14.4 min in the uncemented cup group, being significantly longer in the former (P = 0.0002). In the Kerboull-type plate group and the uncemented cup group, the 5-year survival rates were 100 and 83.9 %, respectively. Recurrent dislocation was observed in two cases in which the posterior approach had been used.
In our study, the loosening of the acetabular components was noted in 14.3 % of uncemented cup-applied cases, but no loosening was noted in any Kerboull-type plate-applied case. Therefore, for RDC, in which objective evaluation of fragile bone quality is difficult, the use of the Kerboull-type plate, which disperses weight-bearing of the acetabular, may be an effective means to achieve early functional recovery as well as a long-term favorable outcome.
已有关于全髋关节置换术(THA)治疗快速破坏性髋关节病(RDC)的临床结果的报道,但据我们所知,尚无比较植入物的研究。本研究的目的是通过比较使用Kerboull型钢板与非骨水泥杯进行THA的临床结果,来检验髋臼重建治疗RDC的有效性。
在2006年至2014年间进行的921例初次THA中,有27例使用Kerboull型钢板或传统非骨水泥杯治疗RDC。13髋使用用于髋臼加强装置的Kerboull型钢板,14髋使用非骨水泥杯。平均随访期为61.2个月。
Kerboull型钢板组手术时间为156.8±36.4分钟,非骨水泥杯组为103.3±14.4分钟,前者明显更长(P = 0.0002)。Kerboull型钢板组和非骨水泥杯组的5年生存率分别为100%和83.9%。在2例采用后入路的病例中观察到复发性脱位。
在我们的研究中,14.3%使用非骨水泥杯的病例出现髋臼部件松动,但使用Kerboull型钢板的病例未出现松动。因此,对于难以客观评估脆弱骨质的RDC,使用能分散髋臼负重的Kerboull型钢板可能是实现早期功能恢复以及长期良好预后的有效手段。