Toni A, Sudanese A, Bueno Lozano A L, Terzi S, Tabarroni M, Busanelli L, Innao V, Giunti A
Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna.
Chir Organi Mov. 1994 Oct-Dec;79(4):319-31.
The results of 79 stem implantations performed between 1981 and 1992 are presented. Mean clinical and radiographic follow-up was obtained 36 months after surgery. All of the prostheses were substituted due to aseptic loosening: of these 68% were cemented. Femoral osteolytic lesions secondary to loosening was classified based on the Paprosky protocol. A severe femoral osteolytic defect (type 2b, 2c or 3 according to Paprosky) was associated with 4% of the cases of loosened cementless prostheses, and with 37% of the cemented ones. Homoplastic bone grafts were used in 40% of the patients. The length of the stems used for reimplantation was short (12-13 cm) in 43%, standard (17-18 cm) in 49%, and long (> or = 22 cm) in 7% of the cases. These stems were cemented in 32% of the cases. The incidence of cementation was different in relation to length, as 62.5% of the short stems were cemented, as compared to 5.3% of the stems of standard length. Clinical results were excellent in 90% of the cases submitted to surgery with short stems, in 80% of those treated with standard stems, and in 50% of the cases of revision surgery where long stems were used. Radiographically, 97% of the short stems were osteointegrated, as compared to 94% of the standard stems and to 25% of the long ones, which were only used in a very few cases to be considered quite complex ones.
本文呈现了1981年至1992年间79例茎干植入手术的结果。术后平均36个月进行了临床和影像学随访。所有假体均因无菌性松动而被替换：其中68%为骨水泥固定型。根据Paprosky方案对因松动导致的股骨溶骨性病变进行分类。严重的股骨溶骨性缺损（Paprosky分类中的2b型、2c型或3型）在4%的非骨水泥固定型假体松动病例中出现，而在骨水泥固定型假体松动病例中的出现率为37%。40%的患者使用了同种异体骨移植。再植入所用茎干长度较短（12 - 13厘米）的病例占43%，标准长度（17 - 18厘米）的占49%，长度较长（≥22厘米）的占7%。这些茎干中有32%进行了骨水泥固定。骨水泥固定的发生率与长度有关，短茎干中62.5%进行了骨水泥固定，而标准长度茎干的这一比例为5.3%。接受短茎干手术的病例中90%临床效果优异，接受标准茎干治疗的病例中80%效果良好，使用长茎干进行翻修手术的病例中50%效果良好。影像学检查显示，97%的短茎干实现了骨整合，标准茎干为94%，长茎干仅在极少数非常复杂的病例中使用，骨整合率为25%。
