Stans A A, Pagnano M W, Shaughnessy W J, Hanssen A D
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 1998 Mar(348):149-57.
From 1969 through 1980, 90 hips in 82 patients had cemented total hip arthroplasty for Type III developmental hip dysplasia. Seventy hips were reviewed at an average of 16.6 years (range, 5-23 years) after operation. Aseptic loosening developed in 53% of acetabular cups and 40% of femoral stems. Despite attempts to place acetabular components in the anatomic center, 18 cups (25.7%) were placed outside that area. Using a measurement method to determine the true acetabular region and approximate femoral head center, final acetabular loosening strongly correlated with initial cup placement. Loosening occurred in 15 of 18 cups (83.3%) initially positioned outside of the true acetabular region compared with loosening in 22 of 52 cups (42.3%) initially positioned within the true acetabular region. Acetabular loosening also correlated with initial lateral displacement or initial superior displacement of the hip center from the approximate femoral head center. Initial cup placement medial to the approximate femoral head center was predictive of successful long term acetabular component fixation. The method of acetabular reconstruction did not affect eventual cup loosening. Placement of the hip arthroplasty center of rotation in or near the true acetabular region is recommended.
1969年至1980年期间，82例患者的90髋接受了骨水泥型全髋关节置换术，用于治疗Ⅲ型发育性髋关节发育不良。对其中70髋在术后平均16.6年（范围5 - 23年）进行了随访。髋臼杯无菌性松动发生率为53%，股骨柄为40%。尽管试图将髋臼组件放置在解剖学中心，但仍有18个髋臼杯（25.7%）放置在该区域之外。使用一种测量方法来确定真正的髋臼区域和近似股骨头中心，最终髋臼松动与初始髋臼杯放置密切相关。最初放置在真正髋臼区域之外的18个髋臼杯中有15个（83.3%）发生松动，而最初放置在真正髋臼区域内的52个髋臼杯中有22个（42.3%）发生松动。髋臼松动还与髋关节中心相对于近似股骨头中心的初始外侧移位或初始上方移位相关。初始髋臼杯放置在近似股骨头中心内侧可预测髋臼组件长期固定成功。髋臼重建方法不影响最终髋臼杯松动情况。建议将髋关节置换术的旋转中心放置在真正髋臼区域内或附近。
