López-Torres Irene Isabel, Sanz-Ruíz Pablo, Sánchez-Pérez Coral, Andrade-Albarracín Ricardo, Vaquero Javier
Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain.
Universidad Complutense de Madrid, Av. Séneca 2, 28040, Madrid, Spain.
Int Orthop. 2018 Aug;42(8):1811-1818. doi: 10.1007/s00264-018-3801-6. Epub 2018 Feb 26.
Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS).
Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years.
The BS group required a significantly greater number of constrained implants (p = 0.001) and more walking aids (p = 0.04). The mean satisfaction (p = 0.02) and HHS scores at the end of the follow-up were higher in the TM group (p = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years.
TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects.
由于严重骨缺损的频率增加以及剩余骨质质量较差，髋臼翻修手术面临挑战。我们比较了复杂髋臼翻修（美国矫形外科医师学会II型、III型和IV型）中常用的两种系统的临床和影像学结果、并发症及生存率：小梁金属系统（TM）和Burch-Schneider抗前突笼（BS）。
2008年至2014年期间，我们中心84例患者接受了TM或BS髋臼翻修手术。对患者的人口统计学和临床特征、满意度、影像学参数、并发症及植入物生存率进行了比较。30.9%的患者植入了BS，而69.1%的患者接受了TM植入物。平均随访时间为4.77年。
BS组需要显著更多数量的限制性植入物（p = 0.001）和更多的助行器（p = 0.04）。随访结束时，TM组的平均满意度（p = 0.02）和髋关节 Harris 评分更高（p = 0.003）。并发症发生率未见差异，不过仅有的两例植入物破裂病例均在BS组。7.5年后总体生存率为88.1%。
在治疗严重髋臼缺损方面，TM植入物比抗前突笼具有更好的临床效果和更高的患者满意度。
