Gustilo R B, Pasternak H S
Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN 55415.
Clin Orthop Relat Res. 1988 Oct(235):111-9.
Fifty-seven hips (55 patients) had revision for failed cemented femoral component loosening using titanium ingrowth femoral components and cancellous bone grafting. The patients' average age was 59 years (range, 25-86 years), and the average follow-up period was 2.8 years (range, two to six years). The preoperative hip score averaged 45.5 (range, 10.0-80.7) and the postoperative hip score averaged 82.5 (range, 43.0-100.0). Complications included dislocation (4.0%), infection (4.0%, one recurrence from a previously infected hip and one acute hematogenous infection), and a 4.0% revision rate for loose femoral component. Another patient had a revision for a loose acetabular component. All parameters of hip function (i.e., pain, limp, activities of daily living, use of support, and distance walked) improved with time. Femoral component loosening is classified into four types based on the severity of loosening and instability. In Type I there is minimal endosteal or inner cortical bone loss, i.e., loosening from the cement-metal-bone interface or a broken stem (seven hips). In Type II there is proximal canal enlargement with cortical thinning of 50% or more and sometimes a lateral wall defect with an intact circumferential wall (23 hips). In Type III there is a posteromedial wall defect involving the lesser trochanter (23 hips). In Type IV there is total proximal circumferential bone loss in varying distances below the lesser trochanter (three hips). The Harris hip scores for the four groups were 93.0, 83.0, 80.0, and 78.0, respectively.
57例髋关节（55例患者）因骨水泥型股骨假体松动失败，采用钛合金长入型股骨假体及松质骨植骨进行翻修。患者平均年龄59岁（范围25 - 86岁），平均随访时间2.8年（范围2 - 6年）。术前髋关节评分平均为45.5（范围10.0 - 80.7），术后髋关节评分平均为82.5（范围43.0 - 100.0）。并发症包括脱位（4.0%）、感染（4.0%，1例为既往感染髋关节复发，1例为急性血源性感染）以及股骨假体松动翻修率为4.0%。另1例患者因髋臼假体松动进行了翻修。髋关节功能的所有参数（即疼痛、跛行、日常生活活动、辅助器具使用及行走距离）均随时间改善。股骨假体松动根据松动和不稳定的严重程度分为四种类型。I型为骨内膜或内皮质骨丢失极少，即从骨水泥 - 金属 - 骨界面松动或假体柄折断（7例髋关节）。II型为近端髓腔扩大，皮质变薄50%或更多，有时伴有完整圆周壁的外侧壁缺损（23例髋关节）。III型为涉及小转子的后内侧壁缺损（23例髋关节）。IV型为小转子下方不同距离处近端圆周骨完全丢失（3例髋关节）。四组的Harris髋关节评分分别为93.0、83.0、80.0和78.0。
