目的探讨初次全髋关节置换术(total hip arthroplasty,THA)中,利用自体股骨头颗粒打压植骨重建髋臼缺损的临床效果。方法回顾性分析2022年4月至2024年6月在南阳市中医院独山院区接受初次THA的PaproskyⅡB型髋臼缺损的16例患者资料,男7例...目的探讨初次全髋关节置换术(total hip arthroplasty,THA)中,利用自体股骨头颗粒打压植骨重建髋臼缺损的临床效果。方法回顾性分析2022年4月至2024年6月在南阳市中医院独山院区接受初次THA的PaproskyⅡB型髋臼缺损的16例患者资料,男7例,女9例;年龄52~70岁,平均(62.62±4.17)岁。所有患者均采用自体股骨头颗粒骨打压植骨技术进行髋臼重建,术后随访评估临床疗效,记录股骨头中心上移距离、假体稳定性、手术指标、并发症等一般情况;采用Harris髋关节评分、疼痛视觉模拟评分(visual analogue scale,VAS)、髋关节活动度、双下肢长度差评价髋关节功能。结果患者均获随访17~37个月,平均(28.25±5.63)个月。手术均顺利完成,假体稳定性良好,未发生严重并发症。末次随访时,患者Harris评分(87.93±1.84)分,VAS评分(2.25±0.68)分,与术前相比显著改善,差异有统计学意义(P<0.05);末次随访时,髋关节屈曲、后伸、内收、外展及内外旋活动度均显著提升,股骨头中心上移显著减少,双下肢长度差显著缩短,与术前相比差异有统计学意义(P<0.05)。结论PaproskyⅡB型髋臼缺损患者在初次THA中采用自体股骨头颗粒植骨修复髋臼内上方骨缺损,能显著改善髋关节功能,提高患者生活质量,临床疗效显著且稳定。展开更多
Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult ...Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases;and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.展开更多
文摘目的探讨初次全髋关节置换术(total hip arthroplasty,THA)中,利用自体股骨头颗粒打压植骨重建髋臼缺损的临床效果。方法回顾性分析2022年4月至2024年6月在南阳市中医院独山院区接受初次THA的PaproskyⅡB型髋臼缺损的16例患者资料,男7例,女9例;年龄52~70岁,平均(62.62±4.17)岁。所有患者均采用自体股骨头颗粒骨打压植骨技术进行髋臼重建,术后随访评估临床疗效,记录股骨头中心上移距离、假体稳定性、手术指标、并发症等一般情况;采用Harris髋关节评分、疼痛视觉模拟评分(visual analogue scale,VAS)、髋关节活动度、双下肢长度差评价髋关节功能。结果患者均获随访17~37个月,平均(28.25±5.63)个月。手术均顺利完成,假体稳定性良好,未发生严重并发症。末次随访时,患者Harris评分(87.93±1.84)分,VAS评分(2.25±0.68)分,与术前相比显著改善,差异有统计学意义(P<0.05);末次随访时,髋关节屈曲、后伸、内收、外展及内外旋活动度均显著提升,股骨头中心上移显著减少,双下肢长度差显著缩短,与术前相比差异有统计学意义(P<0.05)。结论PaproskyⅡB型髋臼缺损患者在初次THA中采用自体股骨头颗粒植骨修复髋臼内上方骨缺损,能显著改善髋关节功能,提高患者生活质量,临床疗效显著且稳定。
文摘Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases;and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.
