Bogoch E R, Fornasier V L, Capello W N
Clin Orthop Relat Res. 1982 Jul(167):92-105.
The femoral head remnant was examined in six patients after Indiana resurfacing arthroplasty. Four hips failed by femoral neck fracture and two by acetabular loosening. Three of the four specimens that failed by fracture had total osteonecrosis, as assessed by histological criteria. The tissue did not evidence foreign body response to methyl-methacrylate, suggesting that osteonecrosis may have occurred at the time of resurfacing arthroplasty. Bony remodeling at the site of fracture indicates that fracture may have occurred through a weakened zone at the junction of viable and necrotic bone. In contrast, examination of the femoral specimens removed owing to acetabular loosening revealed viable bone, membrane formation and a foreign body reaction. The small number of specimens and lack of tetracycline labeling prohibit firm conclusions. These observations nevertheless suggest that resurfacing arthroplasty may, in some cases, cause osteonecrosis of the femoral head remnant, which may play a role in femoral neck fracture. Efforts should be made to obtain the femoral head remnant at autopsy and at revision surgery when indicated so that the state of the femoral head remnant after resurfacing arthroplasty and its role in the success or failure of the various procedures could be better understood.
对6例接受印第安纳表面置换关节成形术的患者的股骨头残端进行了检查。4例髋关节因股骨颈骨折失败，2例因髋臼松动失败。根据组织学标准评估，4例因骨折失败的标本中有3例出现了完全性骨坏死。组织未显示对甲基丙烯酸甲酯的异物反应，提示骨坏死可能在表面置换关节成形术时就已发生。骨折部位的骨重塑表明，骨折可能发生在存活骨与坏死骨交界处的薄弱区域。相比之下，对因髋臼松动而取出的股骨标本进行检查发现有存活骨、膜形成和异物反应。标本数量少且缺乏四环素标记，无法得出确凿结论。然而，这些观察结果表明，表面置换关节成形术在某些情况下可能导致股骨头残端骨坏死，这可能在股骨颈骨折中起作用。应努力在尸检时以及在有指征的翻修手术中获取股骨头残端，以便更好地了解表面置换关节成形术后股骨头残端的状态及其在各种手术成败中的作用。
