植骨技术结合金属网杯重建髋臼骨缺损在全髋关节置换术中的应用  

Reconstruction of acetabular bone defect by using bone grafting combining with titanium mesh and/ or reinforcement cup in total hip arthroplasty

作　　者：陈伟[1] 谷长跃[1] 于庆巍[1] 张远鹰[1] 王金成[1] 

机构地区：[1]吉林大学中日联谊医院骨科,长春130031

出　　处：《中华骨科杂志》2012年第9期823-829,共7页Chinese Journal of Orthopaedics

摘　　要：目的评估植骨技术结合金属网杯重建髋臼骨缺损在全髋关节置换术中的应用价值。方法2008年1月至2011年11月，采用植骨技术结合金属网杯重建全髋关节置换术中髋臼骨缺损32例（32髋），男23例，女9例；年龄51-76岁，平均66岁。初次全髋关节置换6例，翻修26例。PaproskyⅡB型骨缺损12例，采用打压植骨结合钛网重建；ⅡC型骨缺损13例，采用打压植骨结合钛网重建7例、打压植骨结合金属加强杯重建6例；ⅢA型骨缺损7例，采用结构植骨＋打压植骨结合带翼金属加强杯重建6例、双层打压植骨结合钛网及金属加强杯重建1例。疗效通过影像学Gill金属网杯松动评定标准和Harris髋关节评分进行评估。结果全部病例获得随访，随访时间12-25个月，平均22个月。术后12个月Harris髋关节评分由术前（44．00±11．71）分提高至（78．41±9．32）分；优24例、良4例、可4例，优良率87．5％。3例出现髋臼旋转中心轻度移位，1例发生脱位，其余28例未发生固定物松动、下沉及植骨吸收。结论根据髋臼缺损Paprosky分型选择钛网或金属加强杯结合打压植骨或结构性植骨技术，可以重建髋臼骨缺损，从而提高髋臼杯的稳定性．Objective To evaluate effect of bone grafting combining with titanium mesh and/or rein- forcement cup in reconstruction of acetabular bone defect in total hip arthroplasty （THA）. Methods From January 2008 to November 2011, 32 patients, including 23 males and 9 females, aged from 51 to 76 years （average, 66 years）, underwent THA with acetabular defect reconstruction by using bone grafting combining with titanium mesh and/or reinforcement cup. There were 6 cases of primary THA and 26 cases of revision THA. Twelve cases （Paprosky Ⅱ B） and 7 cases （Paprosky Ⅱ C） underwent impaction bone grafting with ti-tanium mesh; 6 cases （Paprosky Ⅱ C） underwent impaction bone grafting with reinforcement cup; 6 cases （Paprosky IU A） underwent impaction bone grafting and structural bone grafting with winged reinforcement cup; 1 case （Paprosky Ⅲ A） underwent double-layer impaction bone grafting with titanium mesh and rein-forcement cup. Harris score and Gill classification were used to evaluate clinical and radiological results, re-spectively. Results All cases （32 hips） were followed up for an average of 22 months （range, 12 to 25 months）. One year postoperatively, Harris score improved from preoperative 44.00±11.71 to postoperative 78.41 ±9.32. Twenty-four cases were excellent, 4 good, 4 fair, and the excellent and good rate was 87.5%. Three cases occurred mild displacement of acetabular rotation center; one case occurred dislocation. There was no loosing, subsidence, and bone resorption in other 28 cases at final follow-up. Conclusion Bone grafting with titanium mesh and/or reinforcement cup is effective in reconstruction of aeetabular bone defect in THA, which can improve the stability of acetabular cup.

关 键 词：髋臼 骨移植 关节成形术 置换 髋 

分 类 号：R687.3[医药卫生—骨科学]