Brinker M R, Rosenberg A G, Kull L, Galante J O
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
J Arthroplasty. 1994 Oct;9(5):457-68. doi: 10.1016/0883-5403(94)90091-4.
Ninety consecutive total hip arthroplasties in 73 patients with osteonecrosis of the femoral head yielded 81 hips in 64 patients (37 men and 27 women) available for evaluation after a 4-8-year follow-up period. The average age at surgery was 39.9 years (range, 20-66 years). Osteonecrosis etiology was idiopathic in 13 hips, alcohol-induced in 15, femoral neck fracture in 12, and slipped capital femoral epiphysis in 2. The remaining 39 cases were related to steroids, which were administered for a variety of reasons. Two types of noncemented, porous-coated, straight-stem femoral components and three types of acetabular components were utilized. Good or excellent clinical results were recorded in 80.2% of the patients. Average Harris hip scores improved from 52.9 to 87.9 points. Nine patients required revision of at least one component and were significantly younger than those with unrevised components. A revision rate of 24.1% was recorded in patients under 35 years of age at the time of primary surgery. Good or excellent clinical results were seen in 92.3% of the idiopathic cases, 86.7% of the alcohol-induced cases, 77.8% of the renal transplant cases, and 62.5% of the systemic lupus erythematosus cases. The overall mortality rate at the follow-up evaluation was 14%; it was 50% in renal transplant patients. Analysis of the clinical results based on the implants showed no significant differences in Harris hip scores or pain and function scores. While total hip arthroplasty using noncemented porous-coated femoral stems appears to give better results than cemented procedures in patients with osteonecrosis of the femoral head, the results appear to be inferior to those reported in patients with other diagnoses.
对73例股骨头坏死患者连续进行了90例全髋关节置换术，在4至8年的随访期后，64例患者（37例男性和27例女性）的81髋可供评估。手术时的平均年龄为39.9岁（范围为20至66岁）。股骨头坏死的病因在13髋中为特发性，15髋为酒精性，12髋为股骨颈骨折，2髋为股骨头骨骺滑脱。其余39例与因各种原因使用的类固醇有关。使用了两种非骨水泥型、多孔涂层、直柄股骨假体和三种髋臼假体。80.2%的患者获得了良好或优秀的临床结果。Harris髋关节平均评分从52.9分提高到87.9分。9例患者需要至少翻修一个假体，且这些患者明显比未翻修假体的患者年轻。初次手术时年龄在35岁以下的患者翻修率为24.1%。特发性病例中92.3%、酒精性病例中86.7%、肾移植病例中77.8%以及系统性红斑狼疮病例中62.5%获得了良好或优秀的临床结果。随访评估时的总死亡率为14%；肾移植患者的死亡率为50%。基于植入物的临床结果分析显示，Harris髋关节评分、疼痛和功能评分无显著差异。虽然在股骨头坏死患者中，使用非骨水泥多孔涂层股骨柄进行全髋关节置换术似乎比骨水泥固定手术效果更好，但结果似乎不如其他诊断患者所报告的结果。
