The three-pin modified 'Harrington' procedure for advanced metastatic destruction of the acetabulum
The three-pin modified 'Harrington' procedure for advanced metastatic destruction of the acetabulum
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DOI：
10.1302/0301-620x.90b1.19892
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发表时间：
2008-01-01
影响因子：
--
通讯作者：
Grimer, R. J.
中科院分区：
文献类型：
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作者：
Tillman, R. M.;Myers, G. J. C.;Grimer, R. J.
因转移性髋臼破坏和髋关节中央脱位而导致的病理性骨折是外科手术的难题。我们描述了一系列使用单一技术的重建，其中使用标准的一期髋关节置换术获得稳定和持久的重建，在需要的情况下，使用坚固的全螺纹钢棒和水泥和钢网。1997至2006年间，19例患者采用改良的Harrington技术治疗，平均年龄66岁(48-83岁)。髋臼破坏分级为Harrington II级6例，III级13例。重建采用3根6.5 mm长的钢棒通过单独的髂骨切开插入，然后用骨水泥和传统的骨水泥Charnley或Exeter一期髋关节置换术完成。无围手术期死亡。最后一次随访(平均25个月，5~110个月)，一根钢棒断裂，一根钢丝钉需要翻修。在18名不需要修改的患者中，13人已经死亡。平均死亡时间16个月(5~55个月)。5名幸存者的平均随访时间为31个月(18~47个月)。没有脱位、深部感染或神经、血管或膀胱损伤的病例。
Pathological fractures due to metastasis with destruction of the acetabulum and central dislocation of the hip present a difficult surgical challenge. We describe a series using a single technique in which a stable and long-lasting reconstruction was obtained using standard primary hip replacement implants augmented by strong, fully-threaded steel rods with cement and steel mesh, where required.Between 1997 and 2006, 19 patients with a mean age of 66 years (48 to 83) were treated using a modified Harrington technique. Acetabular destruction was graded as Harrington class II in six cases and class III in 13.Reconstruction was achieved using three 6.5 mm rods inserted through a separate incision in the iliac crest followed by augmentation with cement and a conventional cemented Charnley or Exeter primary hip replacement. There were no peri-operative deaths. At the final follow-up (mean 25 months (5 to 110)) one rod had fractured and one construct required revision. Of the 18 patients who did not require revision, 13 had died. The mean time to death was 16 months (5 to 55). The mean follow-up of the five survivors was 31 months (18 to 47). There were no cases of dislocation, deep infection or injury to a nerve, the blood vessels or the bladder.