Robinson R P, Lovell T P, Green T M
Adult Hip and Knee Reconstruction Service, Virginia Mason Medical Center, Seattle, Washington.
J Arthroplasty. 1994 Apr;9(2):177-92. doi: 10.1016/0883-5403(94)90067-1.
Fifty-one Cementless Spotorno (CLS, Protek A. G. Berne) stems were implanted in 43 patients with either a Harris Galante (Zimmer, Warsaw, IN) socket or bipolar head. Patients were evaluated at a mean of 31 months. Eighty percent of the hips were in patients who were less than 50 years of age or weighed more than 80 kg. The CLS stem achieved initial stability by wedging a proximally fluted, straight stem into a retained bed of femoral trabecular and cortical bone. Distal canal fill was avoided. The postoperative mean Harris hip score was 95. Eighty percent of the hips were rated excellent, 16% good, 2% fair, and 2% poor. No stem required revision. Six percent had slight, occasional thigh pain. No patient had mild, moderate, or severe thigh pain. Six percent had a limp related to the operated hip. Fifty-three percent of the hips developed a radiographic appearance of bone apposition at the stem tip. Fifty-five percent of the hips had some reduction in proximal bone density. These changes suggested that as bone remodeling occurred, the initial proximal load transfer situation expected from the CLS stem design changed to include some distal load transfer resulting in proximal stress shielding. Ninety-four percent of the hips had either no change in femoral bone density or only patchy loss of density isolated to zone 7. A high dislocation rate was attributed to an unfavorable head-to-neck diameter ratio, a valgus neck shaft angle, and a patient population capable of excellent hip motion.
51枚非骨水泥型Spotorno（CLS，瑞士伯尔尼Protek A.G.公司）股骨柄被植入43例患者体内，这些患者均使用Harris Galante（美国印第安纳州华沙市Zimmer公司）髋臼杯或双极股骨头。对患者进行了平均31个月的随访评估。80%的髋关节患者年龄小于50岁或体重超过80千克。CLS股骨柄通过将近端有凹槽的直柄楔入保留的股骨小梁和皮质骨床来实现初始稳定性，避免了远端髓腔填充。术后Harris髋关节平均评分为95分。80%的髋关节评定为优，16%为良，2%为中，2%为差。没有股骨柄需要翻修。6%的患者偶尔有轻微大腿疼痛，没有患者出现轻、中或重度大腿疼痛。6%的患者因手术侧髋关节出现跛行。53%的髋关节在股骨柄尖端出现骨附着的影像学表现。55%的髋关节近端骨密度有所降低。这些变化表明，随着骨重塑的发生，CLS股骨柄设计预期的初始近端负荷转移情况发生了变化，包括一些远端负荷转移，导致近端应力遮挡。94%的髋关节股骨骨密度无变化或仅7区有散在的密度丢失。高脱位率归因于头颈直径比不理想、颈干角外翻以及患者髋关节活动度良好。
