Slooff T J, Buma P, Schreurs B W, Schimmel J W, Huiskes R, Gardeniers J
Institute of Orthopaedics, University Hospital of Nijmegen, Nijmegen, The Netherlands.
Clin Orthop Relat Res. 1996 Mar(324):108-15. doi: 10.1097/00003086-199603000-00013.
Loosening of primary cemented and noncemented components of total hip arthroplasties always is accompanied by a loss of bone stock. There are several options for reconstruction of the acetabular and femoral defects. The authors' treatment of choice is a standardized cemented revision procedure with tight impaction of morsellized cancellous autograft or allograft chips in acetabular and femoral reconstructions. In this study, the clinical and radiographic evaluation of acetabular defects reconstructed with impacted morsellized allograft femoral heads was described. A cemented cup supplemented with morsellized cancellous grafts and wire meshes in cases of segmental defects was sufficiently stable to allow for complete graft consolidation. After a mean followup of 70 months of 88 hips, 4 cases of clinical failures (including 1 infection) and 6 cases of radiologic failure of the reconstructions were observed, resulting in a failure percentage of 11.4% after 5 years. Autografts and allografts were equally effective. Because the clinical success of the technique also was supported by the results of histologic and biomechanic studies in animals, the authors were encouraged to continue this technique, not only in the acetabulum, but also in the femur.
全髋关节置换术的初次骨水泥型和非骨水泥型假体松动总是伴随着骨量的丢失。髋臼和股骨缺损的重建有多种选择。作者的首选治疗方法是一种标准化的骨水泥翻修手术，在髋臼和股骨重建中紧密嵌入碎松质自体骨或同种异体骨碎片。在本研究中，描述了用嵌入的碎同种异体股骨头重建髋臼缺损的临床和影像学评估。在节段性缺损病例中，补充碎松质骨移植和金属丝网的骨水泥杯足够稳定，可实现移植物完全愈合。对88髋平均随访70个月后，观察到4例临床失败（包括1例感染）和6例重建的影像学失败，5年后失败率为11.4%。自体骨和同种异体骨同样有效。由于该技术的临床成功也得到了动物组织学和生物力学研究结果的支持，作者受到鼓舞继续应用该技术，不仅用于髋臼，也用于股骨。
