比较分析股骨骨丢失：初次翻修手术中未固定与固定无菌干骺端松动-215 例回顾性评估。

Comparative analysis of femoral bone loss: uncemented vs. cemented aseptic stem loosening in first-time revision surgery-a retrospective evaluation of 215 patients.

机构信息

Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.

出版信息

Arch Orthop Trauma Surg. 2024 Aug;144(8):3427-3438. doi: 10.1007/s00402-024-05506-z. Epub 2024 Aug 27.

DOI:10.1007/s00402-024-05506-z

PMID:39191973

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11417084/

Abstract

INTRODUCTION

The integrity of the femoral bone is crucial when considering reconstructive options for the first-time revision of a total hip arthroplasty (THA). Aseptic loosening of primary stems, whether cemented or uncemented, significantly affects the volume and quality of resultant femoral bone loss. This study evaluates the impact of the initial fixation method on femoral bone defect patterns by comparing the extent of bone loss.

MATERIALS AND METHODS

A retrospective cohort of 215 patients with either cemented or uncemented stems, indicated for aseptic stem loosening, and undergoing first-time stem revision from 2010 to 2022 at our institution was analyzed. Femoral bone loss extent at first-time revision was preoperatively gauged using radiographs and categorized by the Paprosky classification. Survival probabilities pre-first-time revision for both stem types were calculated using Kaplan-Meier methods. Hazard ratios were applied to compare the risk of initial revision for uncemented versus cemented stems within the first and subsequent 2nd to 10th years post-primary implantation.

RESULTS

Cemented stems were associated with a higher occurrence of significant bone defects of type 3a (23.53% vs. 14.02%, p = .108), 3b (39.22% vs. 1.22%, p < .001), and 4 (3.92% vs. 0.00%) compared to uncemented stems. Conversely, smaller defects of type 1 and 2 were more prevalent in uncemented stem loosening (84.76% vs. 33.33%, p < .001). Notably, cemented stems exhibited a significantly prolonged revision-free period over the complete decade following primary insertion (p < .001). The unadjusted risk of first-time revision due to stem loosening showed a tendency to an increase in uncemented stems within the initial postoperative year (HR 5.55, 95% CI 0.74; 41.67, p = .096), and an adjusted risk of 2.1 (95% CI 0.26; 16.53, p = .488). However, these differences did not reach statistical significance. In the subsequent 2nd-10th years, the risk was lower compared to cemented stems (HR 2.35, 95% CI 1.39; 3.99, p = .002).

CONCLUSIONS

Uncemented primary stems necessitating first-time revision due to aseptic loosening demonstrated notably smaller femoral bone defects in comparison to primary cemented stems.

摘要

简介

在考虑初次全髋关节翻修的重建方案时，股骨的完整性至关重要。初次使用的骨水泥型或非骨水泥型柄发生无菌性松动，会显著影响股骨骨量丢失的程度和质量。本研究通过比较骨丢失程度，评估初次固定方式对股骨骨缺损模式的影响。

材料与方法

回顾性分析了 2010 年至 2022 年期间我院收治的因初次骨水泥型或非骨水泥型柄无菌性松动而初次行翻修术的 215 例患者的临床资料。术前通过 X 线片评估初次翻修时的股骨骨丢失程度，并采用 Paprosky 分类进行分类。采用 Kaplan-Meier 方法计算两种类型柄初次翻修前的生存概率。应用风险比比较初次植入后第 1 年和第 2 年至第 10 年内，非骨水泥型与骨水泥型柄初次翻修的风险。

结果

与非骨水泥型相比，骨水泥型柄发生显著的 3a 型（23.53%比 14.02%，p = .108）、3b 型（39.22%比 1.22%，p < .001）和 4 型（3.92%比 0.00%）骨缺损的发生率更高。相反，非骨水泥型柄松动导致较小的 1 型和 2 型骨缺损更为常见（84.76%比 33.33%，p < .001）。值得注意的是，在初次植入后的整个 10 年内，骨水泥型柄的无翻修期显著延长（p < .001）。非骨水泥型初次翻修的未调整风险显示出在术后最初 1 年有增加的趋势（风险比 5.55，95%可信区间 0.74；41.67，p = .096），调整后的风险为 2.1（95%可信区间 0.26；16.53，p = .488）。然而，这些差异没有达到统计学意义。在第 2 年至第 10 年，与骨水泥型相比，非骨水泥型的风险较低（风险比 2.35，95%可信区间 1.39；3.99，p = .002）。