远端固定生物型假体在股骨翻修术中的应用

Application of uncemented distal fixation femoral stem combined with allograft in femoral revision with proximal bone defect

目的探讨远端固定生物型假体结合干燥同种异体骨植骨在近端骨缺损股骨翻修术中的应用疗效。方法自1999年7月至2004年1月,对16例(17髋)非感染性股骨假体松动患者进行翻修手术,其中2例为再次翻修,采用远端固定生物型股骨假体结合干燥同种异体骨植骨。男7例,女9例,年龄58～77岁,平均63岁,术后平均随访时间为35个月(18～56个月)。翻修前人工股骨头置换5例,全髋关节置换12例,从初次关节置换到翻修手术的间隔时间最短7年,最长16年,平均13.5年。股骨骨缺损根据Paprosky分型,Ⅰ型8髋,Ⅱ型6髋,ⅢA型3髋。翻修用假体:MP(Link)1髋,AML(DePuy)9髋,Full-coated(Zimmer)5髋,Enchelon(Smith-Nephew)股骨距替代型假体2髋。结果Harris评分从术前平均37分改善至术后平均88分,无患者发生再次松动。术后X线片显示植入骨愈合良好,假体部位骨皮质密度和厚度明显增加。结论远端固定生物型假体可以在股骨远端髓腔内获得可靠的轴向及抗旋转初始稳定性,干燥异体骨植骨能有效修复骨缺损,恢复骨量,骨愈合率高,两者结合运用于伴有近端骨缺损的股骨翻修术中,中短期疗效满意,远期疗效尚待进一步随访。

Objective To evaluate the clinical outcomes of the application of uncemented distal fixation stem combined with allograft in the femoral revision with proximal bone defect.Methods From July 1999 to January 2004, 17 aseptic loosening femoral stem were revised in 16 patients, and 2 of them were rerevision surgery. 7 Males, 9 Females, the average age of patients is 63 （58-77）. The interval between the primary athroplasty and the revision is from 7 years to 16 years. Based on the Paprosky classification system, type Ⅰ was 8 cases; type Ⅱ was 6 cases; type ⅢA was 3 cases. Femoral stems for revision include 1 case of MP stem （Link）, 9 cases of AML stem （DePuy）, 5 cases of Full-coated stem （Zimmer） and 2 cases of Enchelon calcar replacement stem （Smith-Nephew）.Results The average Harris hip score increased from 37 to 88 points. No loosening occurred delete after the revision. The radiographs obtained after the revision showed that bone graft healed well.Conclusions The application of uncemented distal fixation femoral stem combined with allograft could achieve good clinical result in the femoral revision with proximal bone defect.