病灶清除植骨保留髋臼假体的翻修术治疗假体周围局灶性骨溶解  

Revision total hip arthroplasty for focal pelvic osteolysis with well-fixed cementless acetabular component retention by focus clearance and bone graft

作　　者：康鹏德[1] 裴福兴[1] 沈彬[1] 周宗科[1] 杨静[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨科杂志》2010年第10期955-960,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨病灶清除植骨保留髋臼假体的翻修术治疗全髋关节置换（total hip arthroplasty，THA）术后稳定固定的髋臼假体周围局灶性骨溶解的疗效。方法2006年3月至2009年3月，THA术后髋臼假体稳定固定的假体周围局灶性骨溶解患者23例（23髋），男13例，女10例；年龄39-54岁，平均46．6岁。23例均为非骨水泥髋臼。初次THA至诊断髋臼假体周围骨溶解的时间为4．6-7．4年，平均5．5年。术前Harris髋关节评分74分。手术经腹股沟入路，行髂骨内板开窗，清除髋臼骨溶解病灶、同种异体颗粒骨植骨；经后外侧入路更换聚乙烯内衬、股骨头假体，保留髋臼假体。翻修术后1、3、6、12个月及之后每年随访1次，以髋关节Harris评分评价临床疗效，摄X线片、CT扫描观察植骨区愈合、新发骨溶解病灶及假体移位情况。结果16例获得随访，随访时间8-38个月，平均28个月。末次随访时Harris髋关节评分86-100分，平均93．8分。16例植骨区成骨均良好，12例植骨区完全被周围骨爬行替代，髋臼假体固定好，无髋臼假体松动及移位，无新发髋臼假体周围骨溶解，无异位骨化、脱位、深静脉血栓形成及感染等并发症。结论清除病灶植骨、保留髋臼假体、更换聚乙烯内衬和股骨头假体的翻修术可有效减少聚乙烯磨损颗粒产生，避免骨溶解病灶进展导致的假体松动，近期随访结果良好。Objective To evaluate the results of using focus clearance and morselized bone graft to treat a well-fixed socket osteolysis after total hip arthroplasty （THA） during cementless acetabular revisions. Methods From March 2006 to March 2009, 23 patients （23 hips） who had an acetabular revision hip arthroplasty of well-fixed socket for osteolysis were retrospectively reviewed, including 13 males and 10 females with an average age of 46.6 years （range, 39-54）, and the mean interval from primal7 to revision THA was 5.5 years （range, 4.6-7.4）. The preoperative Harris hip score was 74. The operative technique included debridement of soft tissues with removal of granulomata and packed tightly with morselized cancellous allograft through ilioinguinal approach, and exchanging the liner and femoral head through the posterior-lateral approach of the hip. Results The mean duration of follow-up after revision was 28 months （range, 8-38）. At final follow-up, all hip were functioning well and the average Harris hip score was 93.8. Osteogenesis in bone graft were well-developed in 16 patients. Twelve bone grafts were completely incorporated into surrounding bone through creeping substitution. All acetabular components remain radiographically well-fixed and no loosening and shifting. There were no new osteolytic lesions, ectopic ossification, deep venous thrombosis, hip dislocation or infection during follow-up. Conclusion Our revision strategies included debridement and bone grafting, a revision of femoral heads and polyethylene liner and retention of the cups and femoral stems. The method can reduce the amount of the wear particle from polyethylene. The short-term outcome is excellent.

关 键 词：关节成形术 置换 髋 骨质溶解 再手术 

分 类 号：R686[医药卫生—骨科学]