Construct Rigidity: Keystone for Treating Pelvic Discontinuity
Construct Rigidity: Keystone for Treating Pelvic Discontinuity
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DOI：
10.2106/jbjs.16.00601
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发表时间：
2017-05-03
影响因子：
5.3
通讯作者：
Berry, Daniel J.
中科院分区：
文献类型：
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作者：
Martin, J. Ryan;Barrett, Ian;Berry, Daniel J.
背景：骨盆不连续并不常见，给外科医生带来了复杂的重建挑战。本研究的目的是报告当前治疗骨盆不连续性策略的结果。方法：我们回顾性分析了在单一机构进行的 113 例连续翻修全髋关节置换术治疗单侧骨盆不连续性的前瞻性收集数据。该研究包括 18 名男性和 95 名女性患者，进行修复手术时平均年龄为 63 岁。回顾术前、术后即刻和最近的随访X光片，以评估间断的愈合情况以及髋臼假体的稳定性。治疗方式包括带后柱板的非骨水泥杯（50 髋；44%）、杯笼结构（27 髋；24%）、带或不带后柱板的反凸出笼（26 髋；23%）和单独的非骨水泥杯（10 髋；9%）。每种手术重建类型的平均随访时间相似（范围为 3.9 至 7.2 年）。 结果：杯笼结构的种植体五年免翻修存活率最高（100%），带后柱板的非骨水泥杯（80%）和单独的杯（80%）最差。 50%仅使用非骨水泥杯的髋部、74%使用非骨水泥杯和后柱板的髋部、74%使用杯笼结构的髋部和88%使用反突出笼结构的髋部（使用结构性同种异体移植时，这些髋部的91%）实现了不连续性的愈合。总体并发症发生率为26.5%。平均 Harris 髋关节评分从术前 54 分提高到术后 69 分（95% 置信区间：术前 50 至 57 分，术后 65 至 72 分；p = 0.017）。结论：当重建笼用作非骨水泥杯（杯笼）的辅助物或与桥接间断的结构性同种异体移植骨结合使用时，该系列中的存活率和愈合率有所提高。
Background: Pelvic discontinuity is uncommon and presents the surgeon with complex reconstructive challenges. The objective of this study is to report the results of current strategies used in the treatment of pelvic discontinuity.Methods: We retrospectively analyzed prospectively collected data on 113 consecutive revision total hip arthroplasties performed for the treatment of unilateral pelvic discontinuity at a single institution. The study included 18 male and 95 female patients with a mean age of 63 years at the time of revision surgery. Preoperative, immediate postoperative, and latest follow-up radiographs were reviewed to assess healing of the discontinuity as well as acetabular component stability. Treatment modalities included an uncemented cup with a posterior column plate (50 hips; 44%), a cup-cage construct (27 hips; 24%), an antiprotrusio cage with or without a posterior column plate (26 hips; 23%), and an uncemented cup alone (10 hips; 9%). The average duration of follow-up for each of these types of surgical reconstruction was similar (range, 3.9 to 7.2 years).Results: Five-year revision-free survivorship of the implant was best with a cup-cage construct (100%) and worst with an uncemented cup with a posterior column plate (80%) and a cup alone (80%). Healing of the discontinuity was achieved in 50% of the hips with an uncemented cup alone, 74% of the hips with an uncemented cup and a posterior column plate, 74% of the hips with a cup-cage construct, and 88% of the hips with an antiprotrusio cage construct (91% of these hips when structural allograft was used). The overall complication rate was 26.5%. The average Harris hip score improved from 54 preoperatively to 69 postoperatively (95% confidence interval: 50 to 57 preoperatively and 65 to 72 postoperatively; p = 0.017).Conclusions: Improved survivorship and healing rates were seen in this series when a reconstruction cage was used as an adjunct to an uncemented cup (cup-cage) or in combination with structural allograft bone that bridged the discontinuity.