全髋关节翻修术中髋臼骨缺损的处理方法  

A revision total hip arthroplasty for reconstruction of the acetabular bone defects

作　　者：张志强[1] 王北岳[1] 周利武[1] 郭亭[1] 王强 方永超[1] 赵建宁[1] 

机构地区：[1]南方医科大学南京临床医学院(南京军区南京总医院)骨科,江苏省南京市210002

出　　处：《中国骨与关节损伤杂志》2014年第6期531-533,共3页Chinese Journal of Bone and Joint Injury

基　　金：江苏省科技计划项目(BL2012002)

摘　　要：目的探讨全髋关节翻修术中对于髋臼骨缺损重建的方法及其术后疗效。方法回顾性分析自2007-03—2011-12的75例（76髋）全髋关节翻修术,髋臼骨缺损根据Paprosky分型：Ⅰ型9髋,ⅡA型21髋,ⅡB型18髋,ⅡC型11髋,ⅢA型10髋,ⅢB型7髋。髋臼骨缺损采用不同方式修复,术后定期随访。采用髋关节功能Harris评分评估髋关节功能,根据X线片判断假体是否松动、植骨是否融合。结果 75例（76髋）均获得平均36（16~73）个月随访。术后12个月不同类型骨缺损患者髋关节功能Harris评分较术前明显提高,差异有统计学意义（P〈0.05）。术后症状和关节功能明显改善,未出现髋臼骨折、感染、下肢深静脉血栓形成、坐骨神经损伤等严重并发症。X线片可见移植骨与宿主骨质交界处有连续性骨小梁通过,假体未见松动迹象。结论髋臼假体无菌性松动及骨溶解是需要进行全髋关节翻修的主要原因,而髋臼骨缺损Paprosky分型法对髋臼翻修重建方法有指导意义,正确选择假体类型及合理选择植骨方式是全髋关节翻修术后取得满意疗效的保证。Objective To evaluate the treatment and effect of the acetabular defects in revision total hip arthroplasties.Methods A retrospective study was performed on 76 acetabular revision cases（75 patients） performed between Mar. 2007 and Dec. 2011. Among these acetabular loosening cases, 9 cases had a typeⅠ Paprosky acetabular bone defect, 50 cases had a typeⅡ Paprosky acetabular bone defect and 17 cases had a type Ⅲ defect. Different methods were used. The Harris hip score was used to evaluate the hip functions. The X-ray was used to evaluate the loosening of prosthesis and the union of the bone graft. Results The average follow-up was 36 months（16 to 73 months）. After 12 months, the hip joint function Harris score improved obviously compared with preoperative that in patients with different types of bone defect, there was significant difference（P 0.05）. Postoperative symptoms and joint function improved significantly, no acetabulum fracture, infection, lower limb deep vein thrombosis, sciatic nerve damage and other serious complications occurred. Bone graft had continuity with the host bone at the junction of trabecular bone in X-rays, there was no signs of loosening prosthesis. Conclusion This series confirmed that aseptic loosening of prosthesis is the main reason on revision total hip arthroplasty. The classification of Paprosky is meaningful to be used during the acetabular revision. It is important to choose the right method to restore the bone defect and stability of the acetabulum.

关 键 词：全髋关节翻修术 髋臼骨缺损 植骨 

分 类 号：R687.3[医药卫生—骨科学]