非骨水泥假体髋关节翻修术随访研究
摘要
研究背景
随着人工全髋关节置换术(THA)在临床上的广泛应用,大量患者的病痛得到了解除,但随着时间的推移,一些早期植入人体的关节不可避免地出现了假体松动、下沉、位移及骨溶解等并发症,其中有部分患者需行翻修术以再次恢复关节功能。有些接受翻修手术的患者相对年轻,对于此类患者还要考虑到将来可能的再次甚至多次翻修手术。非骨水泥型假体在初次人工全髋关节置换术中的应用效果良好,但在翻修术特别是感染病例的翻修术中应用仍存在争议。因此,本课题对1997-2007年36例41髋在南方医院由同一术者采用非骨水泥型假体行全髋关节翻修术的患者进行回顾性研究并随访1-11年,观察非骨水泥假体中期临床和影像学结果,并为国内外骨科医生选择假体提供临床参考依据。
目的
探讨非骨水泥假体在髋关节翻修术中的临床效果,为骨科医生选择假体提供临床参考依据。
方法
1、病人资料
共36例41髋符合纳入标准。男21例,女15例,平均年龄56岁(21-77岁),平均体重指数21(15-32)。初次置换距翻修术3个月-20年,平均6.7年。翻修原因:无菌性松动22髋,感染性松动7髋,俄关节疼痛不伴明显假体松动5髋(均为人工股骨头置换术后患者),合并股骨假体周围骨折2髋,髋关节僵直2髋,脱位3髋。在41个髋关节翻修术中,29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄。
2、手术方法
术前分别根据AAOS和Paprosky分类方法对骨缺损进行评估,术中处理骨床后根据骨质情况决定假体选择。髋臼侧采用髋臼加强环(acetabularreinforcement ring,ARR)、纯钛螺旋臼或半球形髋臼假体翻修。股骨侧使用无级递增型钛合金假体加长柄翻修,必要时行假体周围植骨,捆绑带固定。感染患者一期翻修4例,二期翻修3例。
3、评估方法
包括临床评估和放射学评估两部分。临床评估指标包括:Hartis评分、术后疼痛时间、术后扶拐行走时间、满意度、并发症等。放射学评估指标包括:异位骨化、骨皮质肥厚、髓内骨化、透亮带、骨溶解、磨损率等。所有数据的采集及评估均由独立检查者完成。磨损数据采用X线片进行测量,并根据已知的股骨头直径(28mm)校正。最后利用Kaplan-Meier生存分析计算假体存活率。
结果
1、临床结果
22例26髋获得完整随访资料,电话随访2例2髋(随访率67%),末次随访前死亡4例4髋(均与关节置换术无关),失访8例9髋,平均随访4.6年(1-11年)。患者平均Harris评分由术前的37.9分(15-76分)增加到末次随访时的86.5分(60-99分),其中其中疼痛、功能评分分别由术前的16.4分和16.7分提高到39.6分和39.6分。术前所有患者均有跛行,末次随访时12例无跛行,8例仅有轻度跛行,4例中度跛行。
2、影像学结果
21髋(75%)假体获得良好稳定性。1髋股骨侧有2mm宽的透亮带形成,临床检查无松动迹象。4髋出现骨溶解并发生移位(股骨1髋,髋臼3髋)而需要再翻修,非骨水泥假体失败率为12.5%。8髋发生异位骨化。聚乙烯平均磨损0.27mm(0.02-0.87mm),年平均磨损量为0.08mm(0-0.25mm)。感染患者无一例术后感染复发,1例股骨假体远端穿出股骨皮质而需翻修。8例使用ARR重建髋臼的患者中7髋获得随访,其中5髋假体获得良好稳定性,2髋因假体周围感染导致髋臼骨溶解而需要再翻修,ARR失败率为29%。
3、统计学结果
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生存分析计算非骨水泥假体4.6年存活率分别为0.89和0.81。将放射学上证明假体松动而需要翻修作为失败的标准时,非骨水泥假体术后4.6年存活率为0.81,其中髋臼假体和股骨假体的存活率分别为0.84和0.91。
结论
1、非骨水泥型假体可用于初次髋关节置换术失败的翻修。
2、以非骨水泥假体翻修髋关节置换术后感染,根据个体感染情况选择一期或二期翻修可取得较满意的临床疗效。
3、感染病例中对固定稳定、与周围骨质间无感染征象的的假体选择不翻修是否可行,有待更多病例的总结。
4、在髋关节翻修术中采用髋臼加强环结合颗粒骨打压植骨的方法能较好地重建髋臼侧严重骨缺损,提供良好的初始稳定性,中期临床效果可令人接受。但对容易造成感染的各种因素必须加强监测,防止感染的发生。
Backgrounds
With the extensive clinical application of total hip arthroplasty(THA),a lot of patient's pain has been relieved.However,with the passage of time,some artificial hips which implanted into body earlier developed some complications,such as prothesis loosening,subsidence,displacement and osteolysis.To this patients,some of whom need a revision hip arthroplasty to restore the function of hip again.Young patients who received revision probably need more than one re-revision operations in the future.The outcomes of using cementless prothesis in primary total hip arthroplasty has been proved good,but there is a dispute that whether cementless prothesis should be used in revision hip arthroplasty,especially in infective cases. This study was conducted to review 41 hips in 36 patients who received revision hip arthroplasty from 1997 to 2007 by a single surgeon using cementless prothesis in Nanfang Hospital,observe the midterm clinical and radiographic outcomes of cementless prothesis,and provide references for orthopedists to select prosthesis in revision hip arthroplasty.
Objective
This study evaluated the clinical and radiographic results of revision hip arthroplasty with cementles prothesis.
Methods
1.Patient data
There were 21 males and 15 females with an average age of 56 years(21-77 years).The mean BMI was 21(15-32).The mean interval between the primary arthroplasty and revision was 3 months to 20 years(mean 6.7 years).The causes for revision were pain without evident component loosing in 5 hips(all underwent an artificial femoral head replacement),infective loosing in 8,aseptic loosening in 21, femoral fracture in 2,ankylosing spondylitis in 2 and dislocation in 3 hips.In the 41 hips,29 hips underwent a revision total hip arthroplasty,8 hips only replaced the acetabular component while 4 hips only did the stem revision.
2.Operation methods
AAOS and Paprosky classification were used respectively to evaluate the bone defect before operation.Proper prothesis was chosed according to the bone defect found during the operation after treating the bone-bed.Acetabular reinforcement ring, titanium threaded cups or hemispherical acetabular prosthesis were used to reconstruct acetabular part,and titanium alloy rectangular revision stems was used as femoral component,bone grafting and circle wire were used when necessary.In the infection cases,one-stage revision was performed in 4 cases,two-stage revision was performed in 3 cases.
3.Evaluation methods
Both clinical evaluation and radiological evaluation were performed.Harris hip score,pain extinction time,crutch walking time,functional capabilities,patient satisfaction and complications were the clinical items involved while the radiological items included heterotopic ossification,cortical hypertrophy,medullary sclerosis, radiolucent lines,osteolysis and wear rate.Data collection and evaluation was accomplished by an independent investigator.Linear wear was measured on radiograghs and was corrected for magnification by comparing the diameter of the femoral head on each individual radiogragh with the known diameter of 28 mm. Kaplan-Meier survivorship analysis was used to estimate the probability of survival of the prothesis.
Results
1.Clinical results
Twenty-two patients(26 hips) were available for complete clinical and radiographic analysis.2 patients were followed only by telephone and 8 patients were completely lost.The mean follow-up period was 4.6 years(1-11 years).The mean Harris hip score improved from 38(11-76) points preoperatively to 88(60-99) points at the time of final follow-up,the pain and function score improved from 16.9 and 17.3 to 40.4 and 39.9 respectively.All patients had moderate to severe limp before revision.At the time of final follow-up,eight patients still had slight limp and 4 patients had moderate limp.
2.Radiographic results
Twenty-one hips(75%) had an excellent result.A 1mm width radiolucent line was found in one femoral component without any symptome.Osteolysis and migration were seen in 4 hips(three in acetabular and one in femoral component), which need re-revision(12.5%failure).Heterotopic ossification developed in 8 hips (31%).The mean polyethylene liner wear was 0.27mm(0.02-0.87mm) in all and 0.08mm(0-0.25mm) per year.In the infective cases,no re-infection was found, femoral component exsertion was found in one patient but without any symptom.In the eight patients who received ARR treatment,seven of which were followed,five hips had an excellent result.Infective osteolysis and migration was seen in 2 hips, which needed re-revision(29%failure).
3.Statistic results
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.With revision for any reason or radiographic loosening as the end point,the 4.6-years survival rate of the cementless prothesis was 0.89 and 0.81 respectively.
Conclusions
1.Cementless prothesis appears to be a good alternative to other revision systems in revision total hip arthroplasty.
2.It is possible to have satisfactory clinical outcome by one-stage or two-stage revision using cementless prothesis for postoperative infection after total hip arthroplasty.
3.Whether the original prothesis can be saved when fixed tightly with femur or acetabular bone needs more experience to confirm in infected hip arthroplasty.
4.ARR with impaction bone grafting is an effective approach to treat massive acetabular bone defect in revision hip arthroplasty,the midterm result is acceptable, but any possible reason for infection must be monitored.
随着人工全髋关节置换术(THA)在临床上的广泛应用,大量患者的病痛得到了解除,但随着时间的推移,一些早期植入人体的关节不可避免地出现了假体松动、下沉、位移及骨溶解等并发症,其中有部分患者需行翻修术以再次恢复关节功能。有些接受翻修手术的患者相对年轻,对于此类患者还要考虑到将来可能的再次甚至多次翻修手术。非骨水泥型假体在初次人工全髋关节置换术中的应用效果良好,但在翻修术特别是感染病例的翻修术中应用仍存在争议。因此,本课题对1997-2007年36例41髋在南方医院由同一术者采用非骨水泥型假体行全髋关节翻修术的患者进行回顾性研究并随访1-11年,观察非骨水泥假体中期临床和影像学结果,并为国内外骨科医生选择假体提供临床参考依据。
目的
探讨非骨水泥假体在髋关节翻修术中的临床效果,为骨科医生选择假体提供临床参考依据。
方法
1、病人资料
共36例41髋符合纳入标准。男21例,女15例,平均年龄56岁(21-77岁),平均体重指数21(15-32)。初次置换距翻修术3个月-20年,平均6.7年。翻修原因:无菌性松动22髋,感染性松动7髋,俄关节疼痛不伴明显假体松动5髋(均为人工股骨头置换术后患者),合并股骨假体周围骨折2髋,髋关节僵直2髋,脱位3髋。在41个髋关节翻修术中,29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄。
2、手术方法
术前分别根据AAOS和Paprosky分类方法对骨缺损进行评估,术中处理骨床后根据骨质情况决定假体选择。髋臼侧采用髋臼加强环(acetabularreinforcement ring,ARR)、纯钛螺旋臼或半球形髋臼假体翻修。股骨侧使用无级递增型钛合金假体加长柄翻修,必要时行假体周围植骨,捆绑带固定。感染患者一期翻修4例,二期翻修3例。
3、评估方法
包括临床评估和放射学评估两部分。临床评估指标包括:Hartis评分、术后疼痛时间、术后扶拐行走时间、满意度、并发症等。放射学评估指标包括:异位骨化、骨皮质肥厚、髓内骨化、透亮带、骨溶解、磨损率等。所有数据的采集及评估均由独立检查者完成。磨损数据采用X线片进行测量,并根据已知的股骨头直径(28mm)校正。最后利用Kaplan-Meier生存分析计算假体存活率。
结果
1、临床结果
22例26髋获得完整随访资料,电话随访2例2髋(随访率67%),末次随访前死亡4例4髋(均与关节置换术无关),失访8例9髋,平均随访4.6年(1-11年)。患者平均Harris评分由术前的37.9分(15-76分)增加到末次随访时的86.5分(60-99分),其中其中疼痛、功能评分分别由术前的16.4分和16.7分提高到39.6分和39.6分。术前所有患者均有跛行,末次随访时12例无跛行,8例仅有轻度跛行,4例中度跛行。
2、影像学结果
21髋(75%)假体获得良好稳定性。1髋股骨侧有2mm宽的透亮带形成,临床检查无松动迹象。4髋出现骨溶解并发生移位(股骨1髋,髋臼3髋)而需要再翻修,非骨水泥假体失败率为12.5%。8髋发生异位骨化。聚乙烯平均磨损0.27mm(0.02-0.87mm),年平均磨损量为0.08mm(0-0.25mm)。感染患者无一例术后感染复发,1例股骨假体远端穿出股骨皮质而需翻修。8例使用ARR重建髋臼的患者中7髋获得随访,其中5髋假体获得良好稳定性,2髋因假体周围感染导致髋臼骨溶解而需要再翻修,ARR失败率为29%。
3、统计学结果
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生存分析计算非骨水泥假体4.6年存活率分别为0.89和0.81。将放射学上证明假体松动而需要翻修作为失败的标准时,非骨水泥假体术后4.6年存活率为0.81,其中髋臼假体和股骨假体的存活率分别为0.84和0.91。
结论
1、非骨水泥型假体可用于初次髋关节置换术失败的翻修。
2、以非骨水泥假体翻修髋关节置换术后感染,根据个体感染情况选择一期或二期翻修可取得较满意的临床疗效。
3、感染病例中对固定稳定、与周围骨质间无感染征象的的假体选择不翻修是否可行,有待更多病例的总结。
4、在髋关节翻修术中采用髋臼加强环结合颗粒骨打压植骨的方法能较好地重建髋臼侧严重骨缺损,提供良好的初始稳定性,中期临床效果可令人接受。但对容易造成感染的各种因素必须加强监测,防止感染的发生。
Backgrounds
With the extensive clinical application of total hip arthroplasty(THA),a lot of patient's pain has been relieved.However,with the passage of time,some artificial hips which implanted into body earlier developed some complications,such as prothesis loosening,subsidence,displacement and osteolysis.To this patients,some of whom need a revision hip arthroplasty to restore the function of hip again.Young patients who received revision probably need more than one re-revision operations in the future.The outcomes of using cementless prothesis in primary total hip arthroplasty has been proved good,but there is a dispute that whether cementless prothesis should be used in revision hip arthroplasty,especially in infective cases. This study was conducted to review 41 hips in 36 patients who received revision hip arthroplasty from 1997 to 2007 by a single surgeon using cementless prothesis in Nanfang Hospital,observe the midterm clinical and radiographic outcomes of cementless prothesis,and provide references for orthopedists to select prosthesis in revision hip arthroplasty.
Objective
This study evaluated the clinical and radiographic results of revision hip arthroplasty with cementles prothesis.
Methods
1.Patient data
There were 21 males and 15 females with an average age of 56 years(21-77 years).The mean BMI was 21(15-32).The mean interval between the primary arthroplasty and revision was 3 months to 20 years(mean 6.7 years).The causes for revision were pain without evident component loosing in 5 hips(all underwent an artificial femoral head replacement),infective loosing in 8,aseptic loosening in 21, femoral fracture in 2,ankylosing spondylitis in 2 and dislocation in 3 hips.In the 41 hips,29 hips underwent a revision total hip arthroplasty,8 hips only replaced the acetabular component while 4 hips only did the stem revision.
2.Operation methods
AAOS and Paprosky classification were used respectively to evaluate the bone defect before operation.Proper prothesis was chosed according to the bone defect found during the operation after treating the bone-bed.Acetabular reinforcement ring, titanium threaded cups or hemispherical acetabular prosthesis were used to reconstruct acetabular part,and titanium alloy rectangular revision stems was used as femoral component,bone grafting and circle wire were used when necessary.In the infection cases,one-stage revision was performed in 4 cases,two-stage revision was performed in 3 cases.
3.Evaluation methods
Both clinical evaluation and radiological evaluation were performed.Harris hip score,pain extinction time,crutch walking time,functional capabilities,patient satisfaction and complications were the clinical items involved while the radiological items included heterotopic ossification,cortical hypertrophy,medullary sclerosis, radiolucent lines,osteolysis and wear rate.Data collection and evaluation was accomplished by an independent investigator.Linear wear was measured on radiograghs and was corrected for magnification by comparing the diameter of the femoral head on each individual radiogragh with the known diameter of 28 mm. Kaplan-Meier survivorship analysis was used to estimate the probability of survival of the prothesis.
Results
1.Clinical results
Twenty-two patients(26 hips) were available for complete clinical and radiographic analysis.2 patients were followed only by telephone and 8 patients were completely lost.The mean follow-up period was 4.6 years(1-11 years).The mean Harris hip score improved from 38(11-76) points preoperatively to 88(60-99) points at the time of final follow-up,the pain and function score improved from 16.9 and 17.3 to 40.4 and 39.9 respectively.All patients had moderate to severe limp before revision.At the time of final follow-up,eight patients still had slight limp and 4 patients had moderate limp.
2.Radiographic results
Twenty-one hips(75%) had an excellent result.A 1mm width radiolucent line was found in one femoral component without any symptome.Osteolysis and migration were seen in 4 hips(three in acetabular and one in femoral component), which need re-revision(12.5%failure).Heterotopic ossification developed in 8 hips (31%).The mean polyethylene liner wear was 0.27mm(0.02-0.87mm) in all and 0.08mm(0-0.25mm) per year.In the infective cases,no re-infection was found, femoral component exsertion was found in one patient but without any symptom.In the eight patients who received ARR treatment,seven of which were followed,five hips had an excellent result.Infective osteolysis and migration was seen in 2 hips, which needed re-revision(29%failure).
3.Statistic results
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.With revision for any reason or radiographic loosening as the end point,the 4.6-years survival rate of the cementless prothesis was 0.89 and 0.81 respectively.
Conclusions
1.Cementless prothesis appears to be a good alternative to other revision systems in revision total hip arthroplasty.
2.It is possible to have satisfactory clinical outcome by one-stage or two-stage revision using cementless prothesis for postoperative infection after total hip arthroplasty.
3.Whether the original prothesis can be saved when fixed tightly with femur or acetabular bone needs more experience to confirm in infected hip arthroplasty.
4.ARR with impaction bone grafting is an effective approach to treat massive acetabular bone defect in revision hip arthroplasty,the midterm result is acceptable, but any possible reason for infection must be monitored.
引文
[1] Harkess JW. Arthroplasty of Hip: Revision of total hip arthroplasty. In Campbell's Operative Orthopaedics. Ninth edition, St.Louis, Mosby Inc., 1998.
[2] Hunter GA, Welsh RP, Camerson HU, et al. The results of revision of total hip arthroplasty. J Bone Joint Surg. 1979, 61:419-423.
[3] Kavanagh BF, Ilstrup DM, Fitzgerald RH. Revision of total hip arthroplasty. J Bone Joint Surg. 1985, 67:517-521.
[4] Dohmae Y, Bechtold JE, Sherman RE, et al. Reduction in cement-bone interface shear strength between primary and revision arthroplasty. Clin Orthop. 1988, 236:214-219.
[5] Garbuz D, Morsi E, Gross AAE. Revision for the acetabular component of total hip arthroplasty with a massive structural allograft.J Bone Joint Surg, 1996, 78:693-699.
[6] Anthony SU, Randall JL, Thomas G. Evaluation of a Porous Tantalum Uncemented Acetabular Cup in Revision Total Hip Arthroplasty: Clinical and Radiological Results of 60 Hips. The Journal of Arthroplasty. 2005, 20(8):1002-1008.
[7] Lerch M, Windhagen H, von Lewinski G. et al. Intraoperative femoral fractures during the implantation of the cementless BiCONTACT stem: a matched-pair analysis of 84 patients. Z Orthop Unfall. 2007, 145(5):574-588.
[8] Brodner W, Bitzan P, et al. Changes in bone mineral density in the proximal femur after cementless total hip arthroplassty. A five-year longitudinal study. J Bone Joint Surg[Br]. 2004, 86:20-26.
[9] Engh c. A Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. JBJS. 1997, 79:177- 184.
[10] Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty: acetabular technique. Clin Orthop. 1994, 298:147-150.
[11] DelLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop. 1976,121:20-32.
[12] Gruen TA, McNeice GM, et al. Modes of failure of cemented stem-type femoral components. Clin Orthop. 1979,141:17-27.
[13] Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement:incidence and a method of classification. J Bone Joint Surg (Am). 1973, 55(8):1629-1632.
[14] Dorr LD, Wan Z. Comparative results of a distal modular sleeve, circumferential coating, and stiffness relief using the Anatomic Porous Replacement Ⅱ. J Arthroplasty. 1996, 11(4):419-428.
[15] Zweymiiller KA, Schwarzinger UM, Steindl MS. Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: a comparison of 6-year and 10-year follow-up results in 95 patients. Acta Orthop. 2006, 77(6):871-876.
[16] Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg Am. 1996, 78:975-981.
[17] Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop. 1990, 257:107-128.
[18] VerberneGA. Femoral head prosthesis with a built-in:A radiographic study of the movements of the two components.J Bone Joint Surg(Br),1983,65:544-552.
[19] Ong BC, Maurer SG, Aharonoff GB, et al. Unipolar Versus Bipolar Hemiarthroplasty: Functional Outcome After Femoral Neck Fracture at a Minimum of Thirty-six Months of Follow-up. J Orthop Trauma. 2002, 16(5):317-322.
[20]Dohmae Y,Bechtold JE,Sherman RE,et al.Reduction in cement-bone interface shear strength between primary and revision arthroplasty.Clin Orthop.1988,236:214-219.
[21]Schmale GA,Lachiewicz PF,Kelly SS.Early failure of revision total hip arthroplasty with cemented precoated femoral components:comparision with uncemented components at 2 to 8 years.J Arthroplasty.2000,15:718-729.
[22]Fritz T,Matthias L,Heike K.Revision total hip arthroplasty with an uncemented primary stem in 79 patients.Arch Orthop Trauma Surg.2008,128(7):673-678.
[23]Zweym(u|¨)ller KA,Steindl M,Schwarzinger U.Good stability and minimal osteolysis with a biconical threaded cup at 10 years.Clin Orthop Relat Res.2007,463:128-137.
[24]Garcia CE,Cruz PA,Madero R,et al.Total hip arthroplasty with use of the cementless Zweym(u|¨)ller alloclassic system:a ten to thirteen year follow-up tudy.J Bone Joint Surg Am.2003,85:296-303.
[25]Snorrason F,K(a|¨)rrholm J.Primary migration of fully-threaded acetabular prostheses.A roentgen stereophotogrammetric analysis.J Bone Joint Surg(Br).1990,72(4):647-652.
[26]寇伯龙,吕厚山,林剑浩.双锥面螺旋臼及加长矩型柄在髋关节翻修术中的应用.中华骨科杂志.2003,23(12):743-746.
[27]Schr(o|¨)der JH,Matziolis G,Tuischer J,et al.The Zweym(u|¨)ller threaded cup:a choice in revision? Migration analysis and follow-up after 6 years.J Arthroplasty.2006,21(4):497-502.
[28]Morag G,Zalzal P,Liberman B,et al.Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip.J Bone Joint Surg Br.2005,87:1068-1072.
[29]Garcia-CE.Porous-coated cementless acetabular cups in revision surgery:a 6-to 11-year follow-up study.J Arthroplasty.1999,14:397-402.
[30]Zehntner MK,Ganz R.Midterm results(5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision.J Arthroplasty.1994,9(5):469-479.
[31]Berry DJ,Muller ME.Revision arthroplasty using an anti-protrusion cage for massive acetabular bone deficiency.J Bone Joint Surg.1992,74:711-715.
[32]Van der Donk S,Buma P,Slooff TJ,et al.Incorporation of morselized bone grafts:a study of 24 acetabular biopsy specimens.Clin Orthop.2002,396:131-141.
[33]戴魁戎,朱振安,孙月华.翻修手术时髋臼巨大骨缺损的重建.中华骨科杂志.2001,6:332-336.
[34]韩一生,朱庆生,吴尧平.加强性网杯在人工全髋关节置换术中的应用及其近期随访结果.中华骨科杂志.2002,12:714-718.
[35]Ganz R,Koch PP,Tannast M,et al.Minimum ten year results of total hip arthroplasty with the acetabular reinforcement ring in avascular osteonecrosis.Int Orthop.2008,32(2):173-179.
[36]Schlegel UJ,Bitsch RG,Pritsch M,et al.Mueller reinforcement rings in acetabular revision:outcome in 164 hips followed for 2-17 years.Acta Orthop.2006,77(2):234-241.
[37]李民进,刘锋.非骨水泥全髋关节髋臼骨溶解的特点及治疗对策.南京医科大学学报(自然科学版),2007,27(9):1016-1019.
[38]Campbell DG,Fracs BS,Garbuz DS,et al.Reliability of acetabular bone defect classificastion system in revision total hip arthroplasty.J Arthroplasty,2001,16:83-86.
[39]Maurer TB,Ochsner P,Schwarzer G,et al.Increased loosening of cemented straight stem protheses made from titanium alloys.An analysis and comprision with prothese made of cobalt-chromium-nickey alloy.Int Othorp,2001,25:77-80.
[40]Bolognesi MP,Marchant MH,Viens NA,et al.The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States.J Arthroplasty.2008,23:92-98.
[41]吴立东,吴锋锋,叶凯山.初次全髋关节置换术后异位骨化.中华骨科杂志,2007,27(12):910-914.
[42]Engh CA Jr,McAuley JP,Sychterz CJ,et al.The accuracy and reproducibility of radiographic assessment of stress-shielding.A postmortem analysis.J Bone Joint Surg Am.2000,82(10):1414-1420.
[1]Pandey R,Berendt AR,Athanasou NA.Histological and microbiological findings in non-infected and infected revision arthroplasty tissues.Arch Orthop Trauma Surg.2000,120:570-574.
[2]Barrack RL,Harris WH.The value of aspiration of the hip joint before revision total hip arthroplasty.J Bone Joint Surg Am.1993,75:66-76.
[3]Peersman G,Laskin R,Davis J,et al.Infection in total knee replacement.A retrospective review of 6489 total knee replacements.Clin Orthop Relat Res.2001,392:15-23.
[4]Austin MS,Ghanem E,Joshi A,A simple cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008,23(l):65-68.
[5] Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992.275:237-42.
[6] Di Cesare PE, Chang E, Preston CF, et al. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. J Bone Joint Surg Am. 2005,87:1921-1927.
[7] 戴尅戎,主编.现代关节外科学.第一版.北京:科学出版社, 2007.
[8] Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 , 90(8): 1637-1643.
[9] Schinsky MF, Delia Valle CJ, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am.2008,90(9):1869-1875.
[10] Barrack RL, Harris WH. The value of aspiration of the hip joint before revision total hip arthroplasty. J Bone Joint Surg Am. 1993,75:66-76.
[11] Barrack RL, Jennings RW, Wolfe MW, et al. The value of preoperative aspiration before total knee revision. Clin Orthop Relat Res. 1997,345:8-16.
[12] Trampuz A, Steckelberg JM, Osmon DR,et al. Advances in the laboratory diagnosis of prosthetic joint infection. RevMedMicrobiol. 2003,14(l):l-14.
[13] Mont MA, Ulrich SD, Delanois RE, et al. Accuracy of cultures and tissue sampling in diagnosing periprosthetic infections. AAOS Proceedings manual,2008:442
[14] Meermans G, Haddad FS. The additional value of tissue biopsy in the diagnosis of infected joint arthroplasty. AAOS Proceedings manual,2008:390
[15] Padgett DE, Silverman A, Sachjowicz F, et al. Efficacy of intraoperative cultures obtained during revision total hip arthroplasty. J Arthroplasty. 1995,10:420-426.
[16] Spangehl MJ, Masri B A, O'Connell JX, et al. Prospective analysis of preoperative and intraoperative investigation for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg(Am). 1999,81 (5):672-683.
[17] Toms AD, Davidson D, Masri BA, et al. The management of periprosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006, 88:149 - 155.
[18] Lonner JH, Desai P, Dicesare PE, et al. The reliability of analysis of intraoperative frozen section for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am.l996,78:1553-1558.
[19] Demirkol MO, Adalet I, Unal SN, et al. 99Tc(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses. Nucl Med Commun. 1997,18:543-548.
[20] Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection of 18F-FDG and 111 In-labeled leukocyte/99mTcsulfur colloid marrow imaging. J Nucl Med. 2004,45:1864-1871.
[21] Kraemer WJ, Saplys R, Waddell JP, et al. Bone scan, gallium scan, and hip aspiration in the diagnosis of infected total hip arthroplasty. J Arthroplasty. 1993,8:611-616.
[22] Chryssikos T, Parvizi J, Ghanem E, et al. FDG-PET imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res. 2008,466(6):1338-1342.
[23] Corless CE, Guiver M, Borrow R, et al. Contamination and sensitivity issues with a real-time universal 16S rRNA PCR. J Clin Microbiol. 2000,38:1747-1752.
[2] Hunter GA, Welsh RP, Camerson HU, et al. The results of revision of total hip arthroplasty. J Bone Joint Surg. 1979, 61:419-423.
[3] Kavanagh BF, Ilstrup DM, Fitzgerald RH. Revision of total hip arthroplasty. J Bone Joint Surg. 1985, 67:517-521.
[4] Dohmae Y, Bechtold JE, Sherman RE, et al. Reduction in cement-bone interface shear strength between primary and revision arthroplasty. Clin Orthop. 1988, 236:214-219.
[5] Garbuz D, Morsi E, Gross AAE. Revision for the acetabular component of total hip arthroplasty with a massive structural allograft.J Bone Joint Surg, 1996, 78:693-699.
[6] Anthony SU, Randall JL, Thomas G. Evaluation of a Porous Tantalum Uncemented Acetabular Cup in Revision Total Hip Arthroplasty: Clinical and Radiological Results of 60 Hips. The Journal of Arthroplasty. 2005, 20(8):1002-1008.
[7] Lerch M, Windhagen H, von Lewinski G. et al. Intraoperative femoral fractures during the implantation of the cementless BiCONTACT stem: a matched-pair analysis of 84 patients. Z Orthop Unfall. 2007, 145(5):574-588.
[8] Brodner W, Bitzan P, et al. Changes in bone mineral density in the proximal femur after cementless total hip arthroplassty. A five-year longitudinal study. J Bone Joint Surg[Br]. 2004, 86:20-26.
[9] Engh c. A Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. JBJS. 1997, 79:177- 184.
[10] Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty: acetabular technique. Clin Orthop. 1994, 298:147-150.
[11] DelLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop. 1976,121:20-32.
[12] Gruen TA, McNeice GM, et al. Modes of failure of cemented stem-type femoral components. Clin Orthop. 1979,141:17-27.
[13] Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement:incidence and a method of classification. J Bone Joint Surg (Am). 1973, 55(8):1629-1632.
[14] Dorr LD, Wan Z. Comparative results of a distal modular sleeve, circumferential coating, and stiffness relief using the Anatomic Porous Replacement Ⅱ. J Arthroplasty. 1996, 11(4):419-428.
[15] Zweymiiller KA, Schwarzinger UM, Steindl MS. Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: a comparison of 6-year and 10-year follow-up results in 95 patients. Acta Orthop. 2006, 77(6):871-876.
[16] Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg Am. 1996, 78:975-981.
[17] Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop. 1990, 257:107-128.
[18] VerberneGA. Femoral head prosthesis with a built-in:A radiographic study of the movements of the two components.J Bone Joint Surg(Br),1983,65:544-552.
[19] Ong BC, Maurer SG, Aharonoff GB, et al. Unipolar Versus Bipolar Hemiarthroplasty: Functional Outcome After Femoral Neck Fracture at a Minimum of Thirty-six Months of Follow-up. J Orthop Trauma. 2002, 16(5):317-322.
[20]Dohmae Y,Bechtold JE,Sherman RE,et al.Reduction in cement-bone interface shear strength between primary and revision arthroplasty.Clin Orthop.1988,236:214-219.
[21]Schmale GA,Lachiewicz PF,Kelly SS.Early failure of revision total hip arthroplasty with cemented precoated femoral components:comparision with uncemented components at 2 to 8 years.J Arthroplasty.2000,15:718-729.
[22]Fritz T,Matthias L,Heike K.Revision total hip arthroplasty with an uncemented primary stem in 79 patients.Arch Orthop Trauma Surg.2008,128(7):673-678.
[23]Zweym(u|¨)ller KA,Steindl M,Schwarzinger U.Good stability and minimal osteolysis with a biconical threaded cup at 10 years.Clin Orthop Relat Res.2007,463:128-137.
[24]Garcia CE,Cruz PA,Madero R,et al.Total hip arthroplasty with use of the cementless Zweym(u|¨)ller alloclassic system:a ten to thirteen year follow-up tudy.J Bone Joint Surg Am.2003,85:296-303.
[25]Snorrason F,K(a|¨)rrholm J.Primary migration of fully-threaded acetabular prostheses.A roentgen stereophotogrammetric analysis.J Bone Joint Surg(Br).1990,72(4):647-652.
[26]寇伯龙,吕厚山,林剑浩.双锥面螺旋臼及加长矩型柄在髋关节翻修术中的应用.中华骨科杂志.2003,23(12):743-746.
[27]Schr(o|¨)der JH,Matziolis G,Tuischer J,et al.The Zweym(u|¨)ller threaded cup:a choice in revision? Migration analysis and follow-up after 6 years.J Arthroplasty.2006,21(4):497-502.
[28]Morag G,Zalzal P,Liberman B,et al.Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip.J Bone Joint Surg Br.2005,87:1068-1072.
[29]Garcia-CE.Porous-coated cementless acetabular cups in revision surgery:a 6-to 11-year follow-up study.J Arthroplasty.1999,14:397-402.
[30]Zehntner MK,Ganz R.Midterm results(5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision.J Arthroplasty.1994,9(5):469-479.
[31]Berry DJ,Muller ME.Revision arthroplasty using an anti-protrusion cage for massive acetabular bone deficiency.J Bone Joint Surg.1992,74:711-715.
[32]Van der Donk S,Buma P,Slooff TJ,et al.Incorporation of morselized bone grafts:a study of 24 acetabular biopsy specimens.Clin Orthop.2002,396:131-141.
[33]戴魁戎,朱振安,孙月华.翻修手术时髋臼巨大骨缺损的重建.中华骨科杂志.2001,6:332-336.
[34]韩一生,朱庆生,吴尧平.加强性网杯在人工全髋关节置换术中的应用及其近期随访结果.中华骨科杂志.2002,12:714-718.
[35]Ganz R,Koch PP,Tannast M,et al.Minimum ten year results of total hip arthroplasty with the acetabular reinforcement ring in avascular osteonecrosis.Int Orthop.2008,32(2):173-179.
[36]Schlegel UJ,Bitsch RG,Pritsch M,et al.Mueller reinforcement rings in acetabular revision:outcome in 164 hips followed for 2-17 years.Acta Orthop.2006,77(2):234-241.
[37]李民进,刘锋.非骨水泥全髋关节髋臼骨溶解的特点及治疗对策.南京医科大学学报(自然科学版),2007,27(9):1016-1019.
[38]Campbell DG,Fracs BS,Garbuz DS,et al.Reliability of acetabular bone defect classificastion system in revision total hip arthroplasty.J Arthroplasty,2001,16:83-86.
[39]Maurer TB,Ochsner P,Schwarzer G,et al.Increased loosening of cemented straight stem protheses made from titanium alloys.An analysis and comprision with prothese made of cobalt-chromium-nickey alloy.Int Othorp,2001,25:77-80.
[40]Bolognesi MP,Marchant MH,Viens NA,et al.The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States.J Arthroplasty.2008,23:92-98.
[41]吴立东,吴锋锋,叶凯山.初次全髋关节置换术后异位骨化.中华骨科杂志,2007,27(12):910-914.
[42]Engh CA Jr,McAuley JP,Sychterz CJ,et al.The accuracy and reproducibility of radiographic assessment of stress-shielding.A postmortem analysis.J Bone Joint Surg Am.2000,82(10):1414-1420.
[1]Pandey R,Berendt AR,Athanasou NA.Histological and microbiological findings in non-infected and infected revision arthroplasty tissues.Arch Orthop Trauma Surg.2000,120:570-574.
[2]Barrack RL,Harris WH.The value of aspiration of the hip joint before revision total hip arthroplasty.J Bone Joint Surg Am.1993,75:66-76.
[3]Peersman G,Laskin R,Davis J,et al.Infection in total knee replacement.A retrospective review of 6489 total knee replacements.Clin Orthop Relat Res.2001,392:15-23.
[4]Austin MS,Ghanem E,Joshi A,A simple cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008,23(l):65-68.
[5] Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992.275:237-42.
[6] Di Cesare PE, Chang E, Preston CF, et al. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. J Bone Joint Surg Am. 2005,87:1921-1927.
[7] 戴尅戎,主编.现代关节外科学.第一版.北京:科学出版社, 2007.
[8] Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 , 90(8): 1637-1643.
[9] Schinsky MF, Delia Valle CJ, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am.2008,90(9):1869-1875.
[10] Barrack RL, Harris WH. The value of aspiration of the hip joint before revision total hip arthroplasty. J Bone Joint Surg Am. 1993,75:66-76.
[11] Barrack RL, Jennings RW, Wolfe MW, et al. The value of preoperative aspiration before total knee revision. Clin Orthop Relat Res. 1997,345:8-16.
[12] Trampuz A, Steckelberg JM, Osmon DR,et al. Advances in the laboratory diagnosis of prosthetic joint infection. RevMedMicrobiol. 2003,14(l):l-14.
[13] Mont MA, Ulrich SD, Delanois RE, et al. Accuracy of cultures and tissue sampling in diagnosing periprosthetic infections. AAOS Proceedings manual,2008:442
[14] Meermans G, Haddad FS. The additional value of tissue biopsy in the diagnosis of infected joint arthroplasty. AAOS Proceedings manual,2008:390
[15] Padgett DE, Silverman A, Sachjowicz F, et al. Efficacy of intraoperative cultures obtained during revision total hip arthroplasty. J Arthroplasty. 1995,10:420-426.
[16] Spangehl MJ, Masri B A, O'Connell JX, et al. Prospective analysis of preoperative and intraoperative investigation for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg(Am). 1999,81 (5):672-683.
[17] Toms AD, Davidson D, Masri BA, et al. The management of periprosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006, 88:149 - 155.
[18] Lonner JH, Desai P, Dicesare PE, et al. The reliability of analysis of intraoperative frozen section for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am.l996,78:1553-1558.
[19] Demirkol MO, Adalet I, Unal SN, et al. 99Tc(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses. Nucl Med Commun. 1997,18:543-548.
[20] Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection of 18F-FDG and 111 In-labeled leukocyte/99mTcsulfur colloid marrow imaging. J Nucl Med. 2004,45:1864-1871.
[21] Kraemer WJ, Saplys R, Waddell JP, et al. Bone scan, gallium scan, and hip aspiration in the diagnosis of infected total hip arthroplasty. J Arthroplasty. 1993,8:611-616.
[22] Chryssikos T, Parvizi J, Ghanem E, et al. FDG-PET imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res. 2008,466(6):1338-1342.
[23] Corless CE, Guiver M, Borrow R, et al. Contamination and sensitivity issues with a real-time universal 16S rRNA PCR. J Clin Microbiol. 2000,38:1747-1752.