Massin P, Tanaka C, Huten D, Duparc J
Service de Chirurgie Orthopédique, Hôpital Bichat, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1998 Feb;84(1):51-60.
One reason for the limited longevity of total hip replacement is the progressive bone loss resulting from iterative loosenings of acetabular components. In the early 80's was developed an experience at our institution for revision surgery of aseptically failed cemented acetabular components using a Müller ring. At that time, this device was used in combination with structural grafts. This appeared to us to be the safest method to address severe acetabular destructions. We are now able to report long term results.
We carried out a retrospective study on 81 cemented acetabular revision arthroplasties performed at our institution between 1981 and 1991. In all cases, there was a segmental or an important cavitary roof defect. Reconstruction of the acetabulum was performed using a superior structural bone graft combined with a Müller ring. Results are given with a mean follow up of 8 years (5-14 years), except in the survivor analysis, in which all patients were included.
There was 15 iterative aseptic loosenings of the acetabular component (in which 5 repeated revisions). Using iterative aseptic loosening of the acetabular component revised or not as an end point, the 10 year cumulative survival rate (CSR) was 0.72 +/- 0.14 and the 11 year CSR was 0.55 +/- 0.24. The position of the hip biomechanical center, the polyethylene thickness, or the type of the superior defect (segmental or cavitary) were not found to influence significantly roentgenographic results.
Reconstruction of severely destroyed acetabuli using this method gave satisfactory results within the first decade. However, the hip function could not be reliably maintained over 10 years. Mechanical failures were related to resorption of weight bearing structural bone grafts. Aseptic iterative loosenings are often moderately symptomatic and yearly roentgenographic controls are necessary to detect late migrations. The lack of long term follow up may result in major bone loss, which can impair the conditions of iterative acetabular reconstructions.
全髋关节置换术使用寿命有限的一个原因是髋臼部件反复松动导致的渐进性骨质流失。20世纪80年代初，我们机构开展了一项使用Müller环对无菌性失败的骨水泥型髋臼部件进行翻修手术的经验。当时，该装置与结构性植骨联合使用。在我们看来，这似乎是处理严重髋臼破坏的最安全方法。我们现在能够报告长期结果。
我们对1981年至1991年在我们机构进行的81例骨水泥型髋臼翻修置换术进行了回顾性研究。所有病例均存在节段性或重要的空洞性髋臼顶缺损。使用上方结构性骨移植联合Müller环进行髋臼重建。除生存分析纳入所有患者外，结果给出的平均随访时间为8年（5 - 14年）。
髋臼部件出现15次反复无菌性松动（其中5次进行了再次翻修）。以髋臼部件是否翻修后的反复无菌性松动为终点，10年累积生存率（CSR）为0.72±0.14，11年CSR为0.55±0.24。未发现髋关节生物力学中心位置、聚乙烯厚度或上方缺损类型（节段性或空洞性）对X线结果有显著影响。
使用这种方法对严重破坏的髋臼进行重建在第一个十年内取得了满意的结果。然而，髋关节功能在10年以上无法可靠维持。机械性失败与负重结构性骨移植的吸收有关。无菌性反复松动通常症状较轻，每年进行X线检查对于检测晚期移位很有必要。缺乏长期随访可能导致严重的骨质流失，这会影响髋臼反复重建的条件。
