长柄全涂层股骨假体结合同种异体骨植骨术在髋关节翻修中的应用  

APPLICATION OF ALL-COATED LONG STEM PROSTHESIS ASSOCIATED WITH ALLOGRAFT IN REVISION TOTAL HIP ARTHROPLASTY

作　　者：赵秀祥[1] 于建华[1] 卜延民[1] 郑得志[1] 

机构地区：[1]天津医院关节中心,天津300211

出　　处：《中国修复重建外科杂志》2009年第7期781-783,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨在髋关节翻修中长柄全涂层股骨假体结合同种异体骨植骨术的临床应用疗效。方法1997年1月-2004年1月,收治20例非感染性股骨假体松动患者。男12例,女8例;年龄58～77岁,平均65岁。均为单髋初次翻修。关节置换至该次翻修手术时间为3～18年,平均12年。股骨侧骨缺损按Paprosky骨缺损分类标准:Ⅱ型10例,ⅢA型6例,ⅢB型3例,Ⅳ型1例。术中采用长柄全涂层股骨假体结合异体骨颗粒打压植骨12例,异体皮质骨结构植骨加打压植骨8例。颗粒骨植骨量5～35g,平均20g;异体骨板长度10～22cm。结果术后伤口均Ⅰ期愈合。1例于术后5d脱位,经闭合复位牵引固定后未再脱位。20例均获随访,随访时间16～48个月,平均36个月。末次随访时Harris评分为(90.0±2.5)分,与术前(50.0±2.3)分比较差异有统计学意义(P<0.05)。术后3年1例股骨假体周围出现3mm透亮带;2例股骨假体分别下沉5mm和7mm;均无明显临床症状,未作处理。患者均未见骨溶解,颗粒骨融合时间3～9个月,平均5个月。7例骨板于术后3年内与宿主骨融合,1例末次随访(术后48个月)仍未融合。结论采用长柄全涂层股骨假体结合同种异体骨植骨术对髋关节置换术后无菌性松动下沉及假体周围骨折进行翻修,可实现假体初始稳定与远近端同时固定。中短期临床和影像学结果满意,远期疗效有待观察。Objective To study the effect of all-coated long stem prosthesis associated with allograft in revision total hip replacement （THR）. Methods From January 1997 to January 2004, 20 patients with non-infectious loosened implant after primary THR were treated. There were 12 males and 8 females with a mean age of 65 years （58-77 years）. The average period between primary THR and revision THR was 12 years （3-18 years）. According to classification of Paprosky, there were 10 cases of type Ⅱ, 6 cases of type ⅢA, 3 cases of type ⅢB and 1 case of type Ⅳ. All-coated long stem prosthesis was used in all cases. Impacting bone grafting was done in 12 cases and impacting bone grafting associated with cortical strut grafting in 8 cases. The mean amount of morselized bone was 20 g （5-35 g）, the length of cortical bone was 10-22 cm. Results All the incisions got healing by first intension. All patients were followed up for an average period of 36 months （16-48 months）. Dislocation occurred at 5 days after operation and was cured with closed reduction and traction in 1 case. There was significant difference （P 〈 0.05） in the mean Harris score between preoperation （50.0 ± 2.3） and postoperation （90.0 ± 2.5）. The X-ray checking showed that continuous radiolucent line of 3 mm occurred in 1 case, prosthesis subsidence of 5 mm and 7 mm in 2 cases and that no bone absorption was observed. Seven cases of cortical bone grafting union was achieved within 3 years except 1 case of cortical bone un-union. Conclusion It can obtained the initial stabilization of prosthesis to use all-coated long stem prosthesis associated with allograft in revision THR to treat femur bone defect after THR. The short-term effects of the clinical and X-ray checking are satisfactory, but future effect is to be observed.

关 键 词：关节成形术 同种异体骨植骨 髋翻修术 假体 

分 类 号：R687.3[医药卫生—骨科学]