Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK.
Int Orthop. 2022 Mar;46(3):433-441. doi: 10.1007/s00264-022-05304-5. Epub 2022 Jan 6.
We developed a technique using an indigenously designed jig to assist pin placement in producing a stable and long-lasting construct to augment the acetabulum combined with a cemented hip replacement in cases of metastatic destruction of the acetabulum. We describe our novel modified Harrington technique and retrospectively assess our cohort's clinical outcomes and complications.
Between 2006 and 2019, 27 patients with a median age of 69 (49-81) years and a median ASA grade of III (II-IV) were managed using our modified 'Harrington' technique. We assessed outcomes on the following criteria: mechanical complications, post-surgery mobility, and functional outcome using Musculoskeletal Tumour Society Score (MSTS).
At the last follow-up, ten patients were alive with disease [median follow-up of 26 months (12-74)], and 17 patients died of their oncological disease [median follow-up of 15 months (9-22)]. There were no perioperative deaths or intra-operative complications in our series. In total, ten complications were noted in nine patients (33%). Mobility-wise, 13 patients (48%) mobilised unaided, ten patients (37%) required a stick or crutch, two patients (7%) required a frame and two patients (7%) were wheel chair-dependent. The median MSTS score of all patients during their latest follow-up was 18 (8-26).
Our jig-aided modified Harrington reconstruction technique assists in safe placement of antegrade pins in acetabulum during surgery and offers a long-lasting solution to these high-risk patients. The use of large diameter pins, appropriate patient selection, and cage used during construction in the acetabulum demonstrated relief of pain, improved mobility, and favorable functional outcomes with minimal complication rates.
我们开发了一种技术，使用本土设计的夹具辅助导针放置，以在转移性髋臼破坏的情况下，为髋臼提供稳定且持久的增强结构，同时结合骨水泥髋关节置换。我们描述了我们新颖的改良哈林顿技术，并回顾性评估了我们的队列的临床结果和并发症。
2006 年至 2019 年，我们使用改良的“哈林顿”技术治疗了 27 例年龄中位数为 69 岁（49-81 岁）、ASA 分级中位数为 III 级（II-IV 级）的患者。我们根据以下标准评估结果：机械并发症、手术后活动能力和肌肉骨骼肿瘤学会评分（MSTS）的功能结果。
在最后一次随访时，10 例患者仍患有疾病（中位随访时间为 26 个月（12-74）），17 例患者因肿瘤疾病死亡（中位随访时间为 15 个月（9-22））。我们的系列中没有围手术期死亡或手术期间并发症。共有 9 例患者（33%）发生了 10 例并发症。在活动能力方面，13 例患者（48%）无需辅助即可活动，10 例患者（37%）需要拐杖或手杖，2 例患者（7%）需要框架，2 例患者（7%）需要轮椅。所有患者在最新随访时的中位 MSTS 评分为 18（8-26）。
我们的夹具辅助改良哈林顿重建技术有助于在手术中安全放置髋臼前路导针，并为这些高危患者提供持久的解决方案。使用大直径导针、适当的患者选择以及在髋臼构建中使用的笼式结构，可缓解疼痛、提高活动能力，并获得良好的功能结果，同时并发症发生率低。
