Ward W G, Dorey F, Eckardt J J
Department of Orthopaedic Surgery, Wake Forest University, Winston-Salem, NC 27157-1070, USA.
Clin Orthop Relat Res. 1995 Jul(316):195-206.
Twenty-one consecutive total femoral replacements performed at 2 institutions were reviewed. The surgical indications varied and included bone loss caused by tumor resections (12 patients), failed prior massive partial femoral endoprostheses (6 patients, 5 of whom had prior tumor resections), or difficult to treat fractures and nonunions (3 patients, 2 of whom had prior endoprostheses). Two patients with tumors died within 2 months. The results in the 19 longer-term survivors were satisfactory in 16 patients (good in 7, fair in 9) and poor in 3. Although not commonly used, when this method was indicated it provided an option to hip disarticulation, which often was the only other viable option. Age was the prime determinant of clinical outcome. Average active hip and knee range of motion was better in younger patients (< 60 years old, 66 degrees and 81 degrees, respectively) than in older patients (> or = 60 years old, 43 degrees and 49 degrees, respectively). All household ambulators required walkers and had a mean age of 81 years; community ambulators requiring 1 cane had a mean age of 46 years; and community ambulators using no walking aids had a mean age of 22 years.
对在两家机构进行的21例连续全股骨置换手术进行了回顾。手术指征各不相同，包括肿瘤切除导致的骨丢失（12例患者）、先前大型部分股骨假体失败（6例患者，其中5例曾有肿瘤切除史）或难以治疗的骨折和骨不连（3例患者，其中2例曾有假体植入史）。两名肿瘤患者在2个月内死亡。19例长期存活患者中，16例结果满意（7例良好，9例尚可），3例结果不佳。尽管这种方法不常用，但在有指征时，它为髋关节离断术提供了一种选择，而髋关节离断术往往是唯一的其他可行选择。年龄是临床结果的主要决定因素。年轻患者（<60岁，平均髋关节和膝关节活动度分别为66度和81度）的平均主动髋关节和膝关节活动范围比老年患者（≥60岁，分别为43度和49度）更好。所有居家活动者都需要助行器，平均年龄为81岁；需要单根手杖的社区活动者平均年龄为46岁；无需助行器的社区活动者平均年龄为22岁。
