摘要
背景:颗粒骨打压植骨是修复髋臼骨缺损的重要方法,对大面积髋臼骨缺损采用打压植骨结合非骨水泥臼杯重建仍然存在争议。目的:探讨同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损的方法及近期疗效。方法:随访2005年6月至2010年4月收治的28例(28髋)AAOSⅢ型髋臼大面积骨缺损患者。男18例,女10例,年龄34～74岁,平均53.8岁。髋关节置换术后感染Ⅱ期翻修9例,骨溶解及髋臼假体松动翻修19例。本组AAOSⅢ型髋臼骨缺损面积大,术中见髋臼骨缺损超过髋臼关节面的50%。全部采用同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术。术后定期随访,观察臼杯有无松动、植入骨与宿主骨整合情况,髋关节功能评分采用Harris评分。结果:28例均获得随访,术后随访时间为13～70个月,平均43个月。Harris评分由术前32～48分,平均41分,提高至末次随访时86～95分,平均90分。28例髋臼假体均固定牢固无松动征象,植入骨逐渐与宿主骨整合,无感染及坐骨神经损伤。结论:在获得臼杯初始稳定固定的情况下,大面积颗粒骨打压植骨(臼杯与宿主骨接触面积<50%)结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损近期疗效较好,远期疗效尚待进一步随访。
Background ： Impaction bone grafting is an important technique for repairing acetabular bone defects in revision hip arthro- plasty. Revising extensive acetabular bone defects with impaction bone grafting and cementless cup remains a controversialtreatment.Objective ： The aim of this study is to investigate the short-term clinical outcomes of acetabular reconstruction for severe acetabular bone defects （ AAOS Ⅲ ） in revision hip arthroplasty.Methods： From June 2005 to April 2010, 28 cases （28 hips） were revised for severe acetabular defects （AAOS Ⅲ ）. There were 18 males and 10 females aged from 34 to 74 years （ mean age 53.8 years）. Among the 28 cases, 19 cases were revised for periprosthetic osteolysis or aseptic loosening and 9 cases received second-stage revision because of periprostheticinfection after total hip arthroplasty. Because of the severe bone defect, less than 50% of the acetahular component was contact with the autologous bone. The bone defect was reconstructed with morselized impaction bone grafting and porous cementless acetahular component in all patients. The patients were followed up to observe the loosening and integration. Harris scores were used to evaluate the function of hip joint.Results： The average follow-up duration was 43 months （range from 13 to 70 months）. The average Harris scores in- creased from 41 （32 -48） points before revision to 90 （86 -95） points at the final follow-up. No sign of acetabular com- ponent loosening was found.Conclusions： The short term effect of extensive impaction bone grafting combined with porous cementless acetabular component in repairing severe acetabular defects （ AAOS llI） is reliable when the anterior column, posterior column and the roof of acetabular are intact. Further follow-up is needed to confirm the long-term results.
出处
《中国骨与关节外科》
2012年第1期22-26,共5页
Chinese Journal of Bone and Joint Surgery
关键词
髋关节成形术
翻修
骨缺损
重建
hip arthroplasty
revision
bone defects
reconstruction
