Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.
Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.
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DOI：
10.1016/0883-5403(94)90135-x
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发表时间：
1994-02-01
期刊：
影响因子：
--
通讯作者：
Lawrence, J M
中科院分区：
文献类型：
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作者：
Paprosky, W G;Perona, P G;Lawrence, J M
从1982年至1988年，147例骨水泥型髋臼部件采用非骨水泥型半球压配部件进行翻修，平均随访时间为5.7年（范围，3-9年）。将髋臼缺损分为1 - 3型，并使用大块或支持性同种异体移植物进行重建。1型缺损在骨水泥锚部位周围存在骨溶解，需要颗粒移植物。2A型和B型缺损表现为上部进行性骨丢失，需要颗粒移植物、股骨头块移植物或髋臼杯上部化。2C型缺损需要使用晶圆股骨头移植物进行内侧壁修复。3A型和B型缺损表现为上级边缘缺损，并采用结构性股骨远端或胫骨近端同种异体移植物进行治疗。147个部件中有6个（4.0%），均为3B型，被认为在影像学和临床上不稳定，避免了翻修。6个中有3个被修改。在X线片上观察到中度外侧同种异体骨吸收，但在翻修时证实了宿主移植物愈合。同种异体移植物的大小、方向和固定方法在结构性同种异体移植物的完整性中起着重要作用，同时必须存在足够的剩余宿主骨以确保骨长入。
From 1982 to 1988, 147 cemented acetabular components were revised with cementless hemispheric press-fit components, with an average follow-up period of 5.7 years (range, 3-9 years). Acetabular defects were typed from 1 to 3 and reconstructed with a bulk or support allograft. Type 1 defects had bone lysis around cement anchor sites and required particulate graft. Type 2A and B defects displayed progressive bone loss superiorly and required particulate graft, femoral head bulk graft, or cup superiorization. Type 2C defects required medial wall repair with wafer femoral head graft. Type 3A and B defects demonstrated progressive amounts of superior rim deficiencies and were treated with structural distal femur or proximal tibia allograft. Six of the 147 components (4.0%), all type 3B, were considered radiographically and clinically unstable, warranting revision. Three of the six were revised. Moderate lateral allograft resorption was noted on radiographs, but host-graft union was confirmed at revision. Size, orientation, and method of fixation of the allografts play an important role in the integrity of structural allografts, while adequate remaining host-bone must be present to ensure bone ingrowth.