Zweymüller SLR-Plus®非骨水泥柄用于髋关节翻修的中期效果

摘要

背景：SL-Plus®非骨水泥柄在初次人工髋关节置换中已取得了很好的疗效，但SLR-Plus®柄在翻修术特别是感染病例翻修过程中的应用效果仍有待观察。目的：观察以Zweymül er SLR-Plus ®非骨水泥柄行髋关节翻修的临床效果。方法：对1997年11月至2013年5月以SLR-Plus ®股骨柄行人工髋关节翻修的39例(41髋)患者进行了随访，其中男26髋，女15髋；年龄34-73岁，平均53岁；翻修骨水泥柄36髋，非骨水泥柄5髋。随访X射线片上的假体变化情况；根据Brooker分类进行异位骨化分级，记录异位骨化发生部位及发生率；对髋关节行Harris功能评定并分析假体生存率。结果与结论：31例33髋获得随访，随访1-16年。患者的平均Harris评分由术前的34分(13-64分)增加到末次随访时的85分(55-94分)。32髋(97%)假体获得良好稳定性；1髋出现1 mm透亮线但无任何症状；1髋出现骨溶解并股骨假体远端穿出股骨皮质而需再翻修；9髋发生异位骨化，其中Brooker 1级2髋，2级4髋，3级3髋；未见术后感染复发。以影像学证明假体松动作为失败标准，利用Kaplan-Meier生存分析方法计算假体随访期间存活率为92%。提示SLR-Plus ®股骨柄具有良好的即刻稳定性及远期稳定性，用于髋关节翻修术中能达到令人较满意的中期效果。%BACKGROUND:The outcomes of SL-Plus® stem in primary total hip arthroplasty have been proved good, but whether SLR-Plus® revision stem can obtain a good outcome in revision hip arthroplasty needs more studies. OBJECTIVE:To observe the clinical results of revision hip arthroplasty with Zweymül er SLR-plus ® stem. METHODS:Revision hip arthroplasty of 41 hips in 39 patients was performed from November 1997 to May 2013 using SLR-plus ® stem. There were 26 hips (male) and 15 hips (female). They were at the age of 34-73 years old, 53 on average. In the 41 hips, 36 cemented and 5 uncemented femoral prostheses were used. Prosthetic changes on radiographs were observed. In accordance with Brooker classification, heterotopic ossification was classified to record the region and incidence of heterotopic ossification. Hip joint function was evaluated using Harris Hip Score, and survival rate of the prosthesis was analyzed. RESULTS AND CONCLUSION:A total of 31 patients (33 hips) were fol owed up for 1 to 16 years. The mean preoperative Harris hip score of 34 (range, 13-64) points improved to 85 (range, 55-94) points at the time of final fol ow-up. 32 hips (97%) had an excellent result. A 1 mm width radiolucent line was found in 1 femoral component without any symptom. Osteolysis and migration were seen in 1 hip, which needed re-revision. Heterotopic ossification developed in 9 hips, including 2 hips of Brooker grade 1, 4 hips of grade 2 and 3 hips of grade 3. No re-infection was found. Kaplan-Meier survivorship was 92%with radiographic loosening as the end point. Results demonstrated that the SLR-Plus® stem has sufficient immediate and long-term stability, which is reliable for patients undergoing hip revision surgery.