Su Weiping, Zeng Min, Hu Yihe, Zhu Jianxi, Wang Long, Xie Jie
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Medicine (Baltimore). 2017 Nov;96(46):e8622. doi: 10.1097/MD.0000000000008622.
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.
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。
