打压植骨结合金属网重建全髋关节翻修术中髋臼侧严重骨缺损  

Management of massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty

作　　者：黄德勇[1] 周乙雄[1] 徐辉[1] 张洪[1] 殷建华[1] 蒋毅[1] 

机构地区：[1]北京大学第四临床医学院北京积水潭医院矫形骨科,北京西城区新街口东街31号100035

出　　处：《中国矫形外科杂志》2007年第23期1781-1784,共4页Orthopedic Journal of China

摘　　要：[目的]探讨在全髋关节翻修术中使用打压植骨技术结合金属网重建严重髋臼骨缺损的方法和效果。[方法]2001年12月至2006年1月应用打压植骨技术结合金属网重建严重髋臼侧骨缺损的患者共有21例21髋,男6例,女15例;翻修时平均年龄为51.9岁（38-77岁）。采用美国骨科医师协会（AAOS）分型,本组患者骨缺损均为AAOSⅢ型（混合型骨缺损）。采用金属网将非包容性骨缺损转变为包容性骨缺损,然后采用7-10 mm的深低温冷冻骨颗粒,使用打压植骨技术恢复骨量,重建髋关节的正常解剖形态,使用骨水泥将聚乙烯臼杯固定于理想的生物力学位置。拍摄术后3 d、3个月、1年及每年随访时的双髋正位片,以泪滴为参照,观察聚乙烯臼杯位置的变化及骨水泥层透亮线的变化,并进行Harris髋关节评分比较。[结果]平均随访2.8年（1-5年）,Harris评分从术前平均46.4分提高到术后81.3分,未发现臼杯松动病例。术后1例脱位,1例有坐骨神经受损症状。[结论]在髋关节翻修术中采用打压植骨技术并结合应用金属网的方法能较好地重建髋臼侧严重骨缺损,恢复骨量,辅助髋臼安放在理想的生物力学位置,并能提供良好的早期稳定性。[Objective]To investigate the method and effeciency of management massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty[Method]Twenty-one patients 21 hips with massive acetabular bone defect were treated with impaction bone grafting plus mesh during Dec 2001 to Jan 2006,including 6 men and 15 women,the average age were 51.9 years at the revision operation（range,38~77 years）.The acetabular defects of the patients in this study group were type III（combined defect）according to the American Academy of Orthopaedic Surgeons（AAOS）classification scheme.At first the combined defect was transformed into cavitary defect with metal mesh,then the contained acetabulum was tightly packed with deep-frozen morselized cancellous allograft chips（size 7~10mm）,the anatomy of the hip was reconstructed and the cup was inserted after pressurizing the cement directly onto the graft.The AP view of the hip at 3 days,3 months,1 year and yearly after the operation were obtained,cup migration according to the teardrop and radiolucent line were evaluated,at the same time the Harris hip score were also evaluated.[Result]The mean follow-up time was 2.8 years,the mean Harris hip score improved from 46.4 points preoperatively to 81.3 points at the final evaluation,no cup migration were found,except for one dislocation and one sciatic nerve injury,as well as lost follow-up for one hip.[Conclusion]Impaction bone grafting plus mesh is an effective approach to treat massive acetabular bone defect in revision total hip arthroplasty,it can restore bone stock and help the cup to be placed to the anatomic position,as well as provide execellent prothesis stability.

关 键 词：关节成形术 置换 髋 打压植骨 翻修术 金属网 

分 类 号：R687.3[医药卫生—骨科学]