Kim Y H, Kim V E
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
J Arthroplasty. 1994 Jun;9(3):243-52. doi: 10.1016/0883-5403(94)90078-7.
The authors studied 50 consecutive and nonselected patients (52 hips) who were followed for a minimum of 7 years (range, 84-89 months) after they had a primary total hip arthroplasty with an uncemented Anatomic Medullary Locking (DePuy, Warsaw, IN) hip system. The average age of the patients at operation was 47.6 years (range, 19-88 years). The operative diagnoses were: avascular necrosis of the femoral head in 18 hips (34%), osteoarthritis in 16 (31%), fracture of the femoral neck in 14 (27%), and miscellaneous in 4 (8%). The average preoperative Harris hip score was 59 points (range, 6-67 points) that improved to 91 points (range, 69-100 points) at the 7-year follow-up examination. To assess the adequacy of intramedullary fit, the fit of the stem at the proximal canal and isthmus level was evaluated. Forty-one hips (79%) had a good press-fit at both the proximal canal and isthmus level, five hips (10%) had a good press-fit at the proximal canal only, and the remaining six hips (11%) had a poor fit at both the proximal canal and isthmus level. Of the 46 hips that had a good press-fit at the proximal canal and/or isthmus level or proximal canal only, 32 (70%) had bone ingrowth and 14 (30%) had stable fibrous tissue ingrowth. Of the remaining six hips with a poor press-fit at both the proximal canal and isthmus level, three (6%) had stable fibrous tissue ingrowth and another three (6%) were unstable. Of the three hips (6%) with femoral component loosening, one was revised and the other two were asymptomatic. There was an alarmingly high incidence of perioprosthetic osteolysis in our series: 16 hips (31%) had acetabular and femoral osteolysis and 13 hips (25%) had femoral osteolysis only. Also, there was a strikingly high incidence of polyethylene-liner wear (12 hips or 23%). Although the incidence of component loosening was low, a high incidence of periprosthetic osteolysis and excessive wear in the polyethylene linear remain challenging problems after insertion of the cementless Anatomic Medullary Locking prosthesis.
作者研究了50例连续且未经挑选的患者（52髋），这些患者在接受初次全髋关节置换术并使用非骨水泥型解剖型髓内锁定（DePuy，华沙，印第安纳州）髋关节系统后，至少随访了7年（范围为84 - 89个月）。患者手术时的平均年龄为47.6岁（范围为19 - 88岁）。手术诊断为：股骨头缺血性坏死18髋（34%），骨关节炎16髋（31%），股骨颈骨折14髋（27%），其他4髋（8%）。术前Harris髋关节评分平均为59分（范围为6 - 67分），在7年随访时提高到91分（范围为69 - 100分）。为评估髓内适配情况，对假体柄在近端髓腔和峡部水平的适配情况进行了评估。41髋（79%）在近端髓腔和峡部水平均有良好的压配，5髋（10%）仅在近端髓腔有良好的压配，其余6髋（11%）在近端髓腔和峡部水平均适配不佳。在近端髓腔和/或峡部水平或仅近端髓腔有良好压配的46髋中（70%）有骨长入，14髋（30%）有稳定的纤维组织长入。在近端髓腔和峡部水平均适配不佳的其余6髋中，3髋（6%）有稳定的纤维组织长入，另外3髋（6%）不稳定。在3髋（6%）出现股骨假体松动的病例中，1髋进行了翻修，另外2髋无症状。我们的系列研究中假体周围骨溶解的发生率高得惊人：16髋（31%）有髋臼和股骨骨溶解，13髋（25%）仅有股骨骨溶解。此外，聚乙烯内衬磨损的发生率也非常高（12髋或23%）。尽管假体松动的发生率较低，但在植入非骨水泥型解剖型髓内锁定假体后，假体周围骨溶解的高发生率以及聚乙烯内衬的过度磨损仍然是具有挑战性的问题。
