Täger G, Täger K H
Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Orthopade. 1994 Nov;23(6):421-9.
The authors present a relatively short followup study of 129 patients who were treated with cementless revision for loosened previous arthroplasties. Elderly patients with a first revision and good bone stock condition were excluded as were septic failures. All patients were treated with cementless, hollow-designed implants. Following previous THA and, also repeated revisions--nearly all of them using a cemented technique--many of the patients developed mostly acetabular, but also femoral loss of bone stock of various quality. Many of these cases required extensive allogenic bone grafting; some of the cases with severe loss of bone stock in young patients necessitated two-stage surgery. Despite this high rate of allografts, no infection occurred. Five patients were revised again for loosening or for femoral fracture; two patients showed sinking of the femoral component and clinical deterioration. The possibilities and advantages of restoration of the implant bed in destructive, aseptic loosening with demanding bone graft and cementless techniques are encouraged by the early results of the patients remobilization and radiologically recognizable revitalization of bone stock. Long-term follow-up will be necessary to evaluate allograft incorporation exactly.
作者对129例因先前关节置换松动而接受非骨水泥翻修治疗的患者进行了一项随访时间相对较短的研究。排除了初次翻修且骨量良好的老年患者以及感染性失败病例。所有患者均接受非骨水泥空心设计的植入物治疗。在先前的全髋关节置换术以及几乎全部采用骨水泥技术的反复翻修之后,许多患者出现了不同程度的骨量丢失,主要是髋臼,但也包括股骨。其中许多病例需要广泛的异体骨移植;一些年轻患者骨量严重丢失的病例需要进行两阶段手术。尽管异体骨移植率很高,但未发生感染。5例患者因松动或股骨骨折再次接受翻修;2例患者出现股骨组件下沉和临床病情恶化。患者早期活动的结果以及影像学上可识别的骨量恢复,鼓励了在伴有大量骨移植需求的破坏性无菌性松动中采用非骨水泥技术修复植入床的可能性和优势。需要进行长期随访以准确评估异体骨的融合情况。