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在全身状况较差的患者中进行髋臼翻修,保留固定但位置不佳的髋臼组件。

Cup revision involving retention of a fixed but malpositioned acetabular component in patients with poor general conditions.

作者信息

Su Weiping, Zeng Min, Hu Yihe, Zhu Jianxi, Wang Long, Xie Jie

机构信息

Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.

出版信息

Medicine (Baltimore). 2017 Nov;96(46):e8622. doi: 10.1097/MD.0000000000008622.

Abstract

This study evaluated the surgical technique and outcomes of cup revision involving retention of a fixed but malpositioned acetabular component in patients with poor general conditions.Between 2007 and 2013, we performed cup revision on 12 hips while retaining a fixed (either cemented or uncemented) but malpositioned acetabular component. Indications for this technique were: malpositioned but fixed acetabular shell; sufficient space for the insertion of the prosthesis; and patients with poor general conditions. After intraoperative confirmation of shell stability, a replacement liner was oriented in a new plane. Clinical and imaging data were collected perioperatively and during follow-up for evaluation of surgical efficacy.No intraoperative complications were encountered. Mean operative duration was 70.4 minutes (range, 45-90 minutes) and mean estimated blood loss was 729 mL (range, 400-1200 mL). Mean follow-up duration was 5.1 years (range, 2.5-8.5 years). Average visual analog scale score decreased from (7.08 ± 1.00) preoperatively to (1.42 ± 0.67) at final follow-up (P < .05). Average Harris Hip Score improved from (14.7 ± 6.58) preoperatively to (80.9 ± 5.30) at final follow-up (P < .05). Anteversions and inclinations of new liners were (15.1 ± 2.3)° and (46.4 ± 3.9)° respectively. Postoperative radiographs showed no signs of prosthesis loosening, periprosthetic fractures, or dislocation compared with preoperatively.The short-term efficacy of cup revision with retention of a malpositioned but fixed acetabular component was satisfactory.

摘要

本研究评估了在全身状况较差的患者中,保留固定但位置不佳的髋臼组件进行髋臼翻修的手术技术及疗效。2007年至2013年期间,我们对12例髋关节进行了髋臼翻修,同时保留固定(骨水泥固定或非骨水泥固定)但位置不佳的髋臼组件。该技术的适应证为:髋臼杯位置不佳但固定;有足够空间插入假体;以及全身状况较差的患者。术中确认髋臼杯稳定性后,在新平面安装置换内衬。围手术期及随访期间收集临床和影像学数据,以评估手术疗效。术中未出现并发症。平均手术时间为70.4分钟(范围45 - 90分钟),平均估计失血量为729毫升(范围400 - 1200毫升)。平均随访时间为5.1年(范围2.5 - 8.5年)。平均视觉模拟评分从术前的(7.08 ± 1.00)降至末次随访时的(1.42 ± 0.67)(P < 0.05)。平均Harris髋关节评分从术前的(14.7 ± 6.58)提高到末次随访时的(80.9 ± 5.30)(P < 0.05)。新内衬的前倾角和外展角分别为(15.1 ± 2.3)°和(46.4 ± 3.9)°。术后X线片显示与术前相比,无假体松动、假体周围骨折或脱位迹象。保留位置不佳但固定的髋臼组件进行髋臼翻修的短期疗效令人满意。

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