非骨水泥假体髋关节翻修术随访报告

Revision of hip arthroplasty with use of cementless prothesis

[目的]探讨非骨水泥假体在髋关节翻修术中的临床效果。[方法]对本科1997年11月～2007年8月行非骨水泥人工全髋关节翻修术36例(41髋)患者进行了随访,其中29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄。随访X线片上的假体变化情况,分析AAOS、Paprosky骨缺损分类对翻修时假体选择的指导作用,对髋关节行Harris功能评定并分析假体生存率。[结果]24例28髋获得随访,平均随访4.6年(1～11年),患者平均Harris评分由术前的38分(11～76分)增加到末次随访时的88分(60～99分)。21髋(75%)假体获得良好稳定性;1髋股骨1区形成2mm宽的透亮线,临床检查无松动迹象;4髋发生骨溶解并假体移位(股骨1髋,髋臼3髋)而需要再翻修,失败率为12.5%;8髋发生异位骨化;聚乙烯衬垫年平均磨损量为0.08mm(0～0.25mm),磨损率仅与外展角变化存在相关。AAOS分类术前、术中的一致性较Parprosky分类高。分别以任何原因进行了再翻修和影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析计算假体4.6年存活率分别为89%、81%。[结论]非骨水泥型假体可用于初次髋关节置换术失败的翻修。术中对骨缺损进行细致的评估并选择合适的假体固定,能达到令人较满意的临床效果。

[ Objective ] To evaluate the clinical and radiographic results of revision hip arthroplasty with cementless prothesis. [ Method] Revision hip arthroplasty of 41 hips in 36 patients was performed from November 1997 to August 2007 using eementless prothesis. In the 41 hips,29 hips underwent a revision total hip arthroplasty, 8 hips underwent new acetabular components, and 4 hips underwent stem revision. Consecutive radiographs were compared to evaluate component conditions. The value of AAOS and Paprosky classification was used. Harris hip scores （HHSs） were determined before surgery and at the most recent follow-up examination. The Kaplan-Meier survivorship analysis was used to estimate the probability of survival of the prothesis. [ Re- sult ] Twenty-two patients （26 hips） were available for complete clinical and radiographic analysis. The mean follow-up period was 4.6 years （ range, 1 - 11 years）. The mean preoperative Harris hip score of 38 （ range, 11 - 76） points improved to 88 （ range,60 -99） points at the time of final follow-up. The pain and function socre improved from 16.9 and 17.3 points to 40.4 and 39.9 points, respectively. All patients had moderate to severe limp before revision. At the time of final follow-up, 8 patients still had slight limp and 4 patients had moderate limp. Twenty-one hips （75%） had an excellent result. A lmm width radiolucent line was found in 1 femoral component without any symptom. Osteolysis and migration were seen in 4 hips （ 3 in acetabular and 1 in femoral component）, which needed re-revision （ 12.5 % failure）. Heterotopic ossification developed in 8 hips （31% ）. The mean polyethylene liner wear was 0.27 mm（ range ,0.02 - 0.87 mm） in all and 0.08 ram（ range ,0 - 0.25 mm） per year. The wear rate was only correlated with changes of abduction angle of the acetabulum. The coincidence of bone defect classification in AAOS is better than Paprosky. Kaplan-Meier survivorship at 4.6 years was 89% with repeat revision for any reason as the end point and 81% with repeat revision or radiographic loosening as the end point. [ Conclusion] Cementless prothesis appears to be a good altemative to other revision systems in revision total hip arthroplasty. Careful intraoperative evaluation of bone deficiency are needed to choose an appropriate prothesis in order to obtain a good outcome.