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相關文獻
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題 名 | Primary Total Hip Arthroplasty without the Use of Bone Cement: A 10-Year Follow-up of 157 Hips=無骨水泥人工髖關節置換--157例平均10年之追蹤報告 |
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作 者 | 謝邦鑫; 施俊雄; 李柏成; 陳志華; 楊文一; | 書刊名 | 長庚醫學 |
卷 期 | 25:5 2002.05[民91.05] |
頁 次 | 頁298-305 |
分類號 | 416.61 |
關鍵詞 | 全人工髖關節置換; 無骨水泥; 骨溶解現象; Total hip arthroplasty; Cementless; Osteolysis; |
語 文 | 英文(English) |
中文摘要 | 背景:無骨水泥固定之人工髖關節置換術乃是發展用以解決無菌性鬆動及骨溶解現象等被認為因骨水泥而引起之併發症。本文將報告我們中期的經驗。 方法:收集173件連續的、未經選擇的,且由同一位醫師以Omnifit廠牌之產品實行的無骨水泥全人工髖關節置換的案例。其中16個案例因追蹤不足而不例入。因此,樣本數為157個案例,平均追蹤達10.2年(範圍5至12年)。 結果:需再置換比率為7.0%。未經再置換者中有93%可達Merle D’Aubigne hip score 16分以上。放射學追蹤則可發現所有髖臼杯及95.2%的股骨柄可見骨長入之証據。骨溶解現象平均出現於術後3.8年。28.1%的股骨及8.9%的骨盆可見此一現象。所有股骨的骨溶解現象皆發生於近端的Gruen第一及第七區。聚乙烯之年平均磨耗為0.15mm。大約有三分之一的案例有過度磨耗的現象。 結論:本文之結果顯示Omnifit無骨水泥固定之全人工髖關節置換可提供足夠之穩定度達至少12年之久。然而,值得特別關注的問題是聚乙烯過度磨耗及伴隨而來之骨溶解現象。我們的經驗同時也指出了近端有環狀孔洞披覆設計的股骨柄能有效使得遠端股骨免於發生骨溶解現象。 |
英文摘要 | Background: The cementless fixation technique in total hip arthroplasty (THA) was developed to solve clinical problems such as aseptic loosening and osteolysis which were thought to be associated with the use of bone cement. This retrospective study reports our mid-term results with cementless THA. Methods: A series of 173 consecutive, unselected cementless THA procedures using the Omnifit prosthesis was performed by a single surgeon. Sixteen hips were excluded from the study because of insufficient follow-up evaluation. One hundred and fifty-seven THAs with an average follow-up period of 10.2 (range, 5-12) years were retrospectively reviewed. Results: The overall revision rate was 7.0%. Ninety-five percent of unrevised hips achieved a Merle D’Aubigne hip score of 16 points or above. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions, seen on 28.1% of femora and 8.9% of pelvises, appeared at an average of 3.8 years postoperatively. Femoral osteolytic lesions were confined to the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately 1/3 of the hips were noted to have excessive wear. Conclusion: These results suggest that cementless Omnifit THA provides stable fixation for as long as 12 years after implantation. Of significant concern is the high incidence of excessive polyethylene wear and associated osteolysis. Our experience also indicates that a femoral stem with a circumferential porous coating in the proximal region can protect the femur from distal osteolysis. |
本系統中英文摘要資訊取自各篇刊載內容。