生物型组配式锥形柄行全髋关节翻修术的中远期疗效

Mid to long-term results of total hip revision with cementless modular tapered stem

目的探讨应用生物型组配式锥形柄行全髋关节翻修术的中、远期疗效。方法收集苏州大学附属第一医院2000年5月至2011年5月因假体无菌性松动、股骨侧骨缺损而采用生物型组配式锥形柄行全髋关节翻修手术的患者,排除肿瘤、假体感染及随访时间<5年的患者,共收录37例(39髋),其中采用利马股骨翻修柄19例(21髋),林克(LINK) MP翻修柄18例(18髋)。初次置换至翻修时间为4～15年,平均(10±4)年,均为首次翻修。股骨侧骨缺损分型按Paprosky标准:Ⅲa型28髋,Ⅲb型11髋。摩擦界面均使用陶瓷-陶瓷界面。Harris评分比较采用t检验,骨缺损程度分型组间差异采用卡方检验。结果全部病例随访6～16年,其中11例随访6～10年,26例随访超过10年,平均(11. 6±2. 3)年。两种假体翻修时股骨缺损程度未见明显差异(2=0. 434; P> 0. 05)。术前平均Harris髋关节评分为(43±10)分,末次随访为(90±3)分(t=32. 334,P <0. 05),两种翻修假体的临床疗效差异无统计学意义(t=0. 881,P> 0. 05)。X线随访显示翻修柄骨性稳定者38髋(97. 4%),纤维稳定者1髋(2. 6%)。假体平均下沉(2. 1±2. 3) mm(0～10 mm)。随访期间无1例因假体松动或其他原因需行再次翻修。结论采用生物型组配式锥形柄假体行伴有PaproskyⅢa和Ⅲb型骨缺损的股骨侧假体翻修,可获得理想的初始稳定和永久生物学固定,中、远期随访疗效满意。

Objective To evaluate medium and long term results of the revision total hip replacement with the cementless,modular,tapered stem.Methods From May 2000 to May 2011,the patients with tumors,prosthetic infections and follow-up for less than five years were excluded;37 patients(39 hips)underwent total hip revision surgery with cementless modular tapered stem in the First Affiliated Hospital of Soochow University due to aseptic loosening and bone defect of femur.This study included 21 hips revised with the Lima(Lima-Lto,Udine,Italy)prosthesis and 18 hips revised with the Link MP(Waldemar Link,Hamburg,Germany)prosthesis.The time from primary total hip arthroplasty to revision was four to 15 years,(10.4±3.7)years on average.First revision was given in all the patients.Pre-revision diagnosis showed type IIIa(Paprosky classification)in 28 hips,type IIIb in 11 hips.All the bearing surfaces using ceramic-ceramic hip bearings.Harris scores were compared by t test,while the bone defection type was analysed by chi-square test.Results The mean follow-up time was(11.6±2.3)years(range,6~16 years).Among the patients,26 patients were evaluated at a minimum follow-up time of 10 years.There was no significant difference in femoral defect between two kinds of prosthesis revision(2=0.434;P>0.05).The Harris hip score was(43±10)preoperatively and maintain(90±3)at the latest follow-up(t=32.334;P<0.05).There was no statistical difference in the clinical effect between the two kinds of revision prostheses(t=0.881;P>0.05).The X-ray films showed bone ingrowths fixation in 38 hips(97.4%)and fibrous stable fixation in one hip(2.6%).The average stem subsidence was(2.1±2.3)mm(range,0-10 mm).There was no re-revision of the femoral stem for any reason.Conclusion The mid-long term results of revision total hip replacement with the cementless,modular,tapered stem are encouraging in Paprosky type IIIa and IIIb femoral defect associated aseptic loosening of the femoral stem.