初次双动全髋关节置换术中使用 Libra 骨水泥型与非骨水泥型柄的中期结果。
Medium-term outcome of the Libra cemented versus cementless stems in primary dual mobility total hip arthroplasty.
机构信息
Department of Orthopedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Menoufia, 32511, Egypt.
出版信息
BMC Musculoskelet Disord. 2023 Aug 21;24(1):663. doi: 10.1186/s12891-023-06799-8.
INTRODUCTION
Despite the increasing use of cementless stems in total hip arthroplasty, the cemented stem has played a valuable role in the armamentarium of orthopedic surgeons. This study aims to compare two types of Libra® stems SERF, one cemented (Libra® C) and the other cementless hydroxyapatite coated (Libra® HA) that were conducted to analyze the medium-term outcome regarding their behavior and longevity.
METHODS
This is a retrospective study for patients who received primary total hip arthroplasty with Dual Mobility (DM) articulation in the period between January 2014 to January 2020 with a minimum of two years follow-up. Two-hundred hips have been identified in 196 patients. One hundred forty-three Libra® cementless versus fifty-seven Libra cemented stems were implanted and the outcome of these stems is reported. All procedures were performed through the posterior approach and cemented stems were selected for elderly patients with wide medullary canals Dorr Type C. The indications for the index procedure were fractures, avascular necrosis, rheumatoid, and osteoarthritis. One hundred thirty-nine cementless DM cups were used while sixty-one hips had cemented Novae stick cups. Radiological evaluation for cup and stem positions, cement mantle, and radiolucent lines was performed, besides clinical function using the Harris Hip Score.
RESULTS
The average age of patients was 60 ± 14.8. At the latest review, none of the cemented stems was revised or awaiting revision. One cementless stem was revised because of cortical perforation. Five intraoperative fractures were observed in the cementless group, but none of them needed revision or affected the stem stability. Readmission to theatre occurred in four patients to evacuate hematoma in two, a reduction of dislocation in one, and grafting bone lysis in one.
CONCLUSION
Cemented stems have an important role in osteoporotic patients with wide medullary canals with excellent outcomes and minimal risk of fracture.
LEVEL OF EVIDENCE
Level IV.
简介
尽管在全髋关节置换术中越来越多地使用非骨水泥假体，但骨水泥假体在骨科医生的治疗手段中仍具有重要地位。本研究旨在比较两种 Libra® 假体，一种为骨水泥型（Libra® C），另一种为非骨水泥型羟基磷灰石涂层（Libra® HA），分析其中期疗效和长期生存率。
方法
这是一项回顾性研究，纳入了 2014 年 1 月至 2020 年 1 月期间接受双动（DM）关节全髋关节置换术且至少随访 2 年的患者。共识别出 196 例患者的 200 髋。其中植入 143 例 Libra® 非骨水泥假体和 57 例 Libra 骨水泥假体，报告这些假体的结果。所有手术均经后路入路完成，骨水泥型假体选择用于髓腔宽大的老年患者（Dorr 型 C 型）。该指数手术的适应证为骨折、股骨头缺血性坏死、类风湿关节炎和骨关节炎。139 例使用非骨水泥 DM 杯，61 例使用骨水泥 Novae 杯。除了使用 Harris 髋关节评分评估临床功能外，还对杯和假体位置、骨水泥覆盖和透亮线进行了放射学评估。
结果
患者的平均年龄为 60±14.8 岁。在最近一次随访中，没有骨水泥假体需要翻修或等待翻修。1 例非骨水泥假体因皮质穿孔而翻修。在非骨水泥组中观察到 5 例术中骨折，但均无需翻修或影响假体稳定性。有 4 例患者需要再次手术以清除血肿（2 例）、复位脱位（1 例）和骨溶解植骨（1 例）。
结论
在髓腔宽大的骨质疏松患者中，骨水泥假体具有重要作用，可获得良好的效果，且骨折风险极小。
证据等级
IV 级。
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