摘要
目的探讨在全髋关节翻修术中对髋臼骨缺损修复、重建髋臼的方法。方法对21例(21髋)患者采用金属网罩、异体颗粒松质骨打压植骨和骨水泥固定聚乙烯髋臼杯的技术修复髋臼骨缺损、重建髋臼;平均随访47个月;评估临床结果、宿主骨与移植骨的愈合、髋臼杯位置变化。结果Harris 评分由平均55.7分提高到92.9分;骨愈合时间平均为11.4个月。髋臼杯外展角平均改变2.2°,20髋平均1.5°;1髋15.5°。术后3个月,平均增加1.7°;术后6个月增加2.0°;以后变化不明显。髋臼杯内侧平均移位3.93 mm,其中4 mm 以下15髋,4 mm 以上6髋;向上移位平均4.41 mm,其中4 mm 以下14髋,4 mm 以上7髋;术后3个月,向内侧和上方平均各移位3.21、3.97 mm(P<0.05);术后6个月分别为3.89、4.30 mm(P<0.05),以后移位不明显。1例因髋臼杯假体松动行再次翻修。结论金属网罩加固髋臼底部和边缘、异体颗粒松质骨打压植骨修复骨缺损和骨水泥固定聚乙烯髋臼杯的技术重建髋臼后,髋臼杯位置的变化主要发生在术后6个月内,保持关节假体良好的初始稳定性,可以提高髋臼杯的稳定性。
Objective To discuss the method of reconstruction of acetabular bone defect with wire mesh, impoction bone-grafting and a cemented cup in acetabular component revision. Methods 21 hips in 21 patients, aged 50. 1 （31-64）, 2 hips being of the acetabular defect type Ⅰ B, 1 hip of type Ⅱ A, 4 hips of type Ⅱ B, and 14 hips of type m according to the American Academy of Orthopaedic Surgeons （AAOS） grading system underwent reconstruction with wire mesh, impacted bone grafts and cemented polyethylene acetabular component, and then were followed up for 47 months （36-60 months）. Results The mean Harris hip score improved from the preoperative 55.7 points to 92.9 points at the last time of follow-up. Radiographic incorporation between host the bone and allograft was achieved 11.4 months after the operation on average. The mean change of inclination of acetabular components was 2. 2°, in which one acetabular component developed a change of 15.5°. The inclination of acetabular components increased by 1.7° on average 3 months after the operation and 2. 0° 6 months after the surgery. The acetabular cup migrated medially and superiorly by 3. 93 mm and 4.41 mm respectively, peaking in the sixth month after the operation. One hip developed heterotopic ossification （Brooker grade Ⅰ ）. One hip received repeat revision because of the aseptic loosening of the acetabular component 25 months after the revision surgery. Conclusion The changes of the position of acetabular cup mainly occur within six months after the reconstruction of severe acetabular bone defect with wire mesh, impacted bone graft and cemented polyethylene acetabular component. To prevent the displacement of the acetabular cup, it is necessary to keep initial stability of the acetabular cups within six months after the index surgery.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第23期1603-1606,共4页
National Medical Journal of China
关键词
髋臼
再手术
再植术
Acetabulum
Reoperation
Replantation
