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采用未骨水泥固定的Harris-Galante多孔涂层髋臼组件进行全髋关节置换翻修术。5至12年结果的随访记录。

Revision of a total hip arthroplasty with a Harris-Galante porous-coated acetabular component inserted without cement. A follow-up note on the results at five to twelve years.

作者信息

Lachiewicz P F, Poon E D

机构信息

Department of Orthopaedics, University of North Carolina at Chapel Hill, 27599-7055, USA.

出版信息

J Bone Joint Surg Am. 1998 Jul;80(7):980-4. doi: 10.2106/00004623-199807000-00006.

Abstract

Fifty-seven revision total hip arthroplasties in fifty-six patients were performed with a Harris-Galante porous-coated acetabular component by one surgeon, and the patients were followed prospectively for a mean of seven years (range, five to twelve years). A trochanteric osteotomy was performed in forty hips, and a posterior approach with an extended anterior capsulectomy was used in the other seventeen. The acetabular defect was classified as segmental in seven hips, cavitary in twenty-three, and combined in twenty-one; six hips had no notable defect. A bulk allograft was used in eleven hips, and morseled cancellous-bone allograft or autogenous graft was used in thirty-four hips; twelve hips did not have bone-grafting. Both the femoral and the acetabular component were revised in forty-five hips, and only the acetabular component was revised in twelve. Thirty-nine hips (68 per cent) had a good or excellent clinical result according to the Harris hip score. The acetabular component was well fixed in the fourteen hips that had a fair result and the four hips that had a poor result. The acetabular component was considered to have migrated if there was a change in the angle of the cup of 5 degrees or more or a change in the horizontal or vertical position of the cup of more than three millimeters. Despite varying degrees of bone loss, no acetabular component had radiographic evidence of loosening at the latest follow-up examination. No component was revised and no revisions were scheduled. One hip was debrided for a late metastatic infection, but the component was well fixed and was not revised. There were no complications related to the use of screws for fixation. These mid-term results confirm the early success of acetabular revisions performed with fixation of a titanium fiber-metal-coated hemispherical component with multiple screws and no cement.

摘要

一位外科医生对56例患者进行了57次全髋关节翻修手术,采用Harris-Galante多孔涂层髋臼组件,对患者进行了平均7年(范围5至12年)的前瞻性随访。40例髋关节进行了转子截骨术,另外17例采用后入路并扩大前关节囊切除术。髋臼缺损在7例髋关节中为节段性,23例为空洞性,21例为混合型;6例髋关节无明显缺损。11例髋关节使用了大块同种异体骨,34例髋关节使用了碎松质骨同种异体骨或自体骨移植;12例髋关节未进行骨移植。45例髋关节同时翻修了股骨和髋臼组件,12例仅翻修了髋臼组件。根据Harris髋关节评分,39例髋关节(68%)临床结果为良好或优秀。髋臼组件在结果一般的14例髋关节和结果较差的4例髋关节中固定良好。如果髋臼杯角度变化5度或更多,或者髋臼杯水平或垂直位置变化超过3毫米,则认为髋臼组件发生了移位。尽管存在不同程度的骨丢失,但在最近的随访检查中,没有髋臼组件有影像学松动证据。没有组件需要翻修,也没有安排翻修手术。1例髋关节因晚期转移性感染进行了清创,但组件固定良好,未进行翻修。没有与使用螺钉固定相关的并发症。这些中期结果证实了使用多枚螺钉且无骨水泥固定的钛纤维金属涂层半球形组件进行髋臼翻修的早期成功。

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