钽金属Jumbo杯在PaproskyⅡ及Ⅲ型髋臼缺损髋关节翻修中的应用  

Reconstruction of acetabular bone loss with porous tantalum Jumbo acetabular component in revision hip arthroplasty

作　　者：古凌川[1] 陈光兴[1] 杨柳[1] 何锐[1] 彭阳[1] 杨鹏飞[1] 

机构地区：[1]第三军医大学西南医院关节外科,重庆400038

出　　处：《第三军医大学学报》2015年第17期1776-1781,共6页Journal of Third Military Medical University

摘　　要：目的观察钽金属Jumbo杯在全髋关节翻修术中对PaproskyⅡ型及以上严重髋臼骨缺损进行重建的疗效。方法收集2009年9月至2012年9月行钽金属Jumbo杯重建中、重度髋臼缺损髋关节翻修手术18例（18髋）患者的临床资料,包括男性8例,女性10例,年龄37~76（56.8±15.3）岁。Paprosky分型Ⅱb型6例,Ⅱc型7例,Ⅲa型2例,Ⅲb型3例。术后观测其髋关节Harris评分、视觉模拟疼痛评分（visual analogous scale,VAS）、髋臼假体[位置、稳定性、骨长入（Anderson影像学标准）、生存率]情况及并发症。结果全部病例术后随访时间24~54个月,平均35.7个月。末次Harris评分PaproskyⅡ型为（84.8±11.8）分,明显高于术前（48.3±12.5）分（t=-13.8,P〈0.01）;Ⅲ型为（77.8±9.3）分,明显高于术前（38.5±10.6）分（t=-16.4,P〈0.01）。末次VAS评分PaproskyⅡ型为（1.1±0.7）分,明显低于术前（3.8±1.5）分（t=14.7,P〈0.01）;Ⅲ型为（1.9±1.2）分,明显低于术前（5.1±1.6）分（t=19.2,P〈0.01）。随访期内钽金属Jumbo杯固定良好,未出现松动及移位,髋臼杯均出现不同程度骨长入,均未发现臼杯周围透光线、骨溶解,假体生存率100.0%。术后4周出现假体后脱位1例,均无感染、神经损伤等并发症发生。结论钽金属Jumbo杯重建中、重度髋臼缺损髋关节翻修手术的近期疗效优良,并具有简化手术操作、减少植骨需求、增加与宿主骨接触面、利于宿主骨长入、最大限度恢复旋转中心的优点。Objective To explore the short-term efficacy of the reconstruction of acetabular bone loss with porous tantalum Jumbo acetabular component in revision hip arthroplasty. Methods Eighteen patients（ 18 hips） admitted in our center from september 2009 to september 2012 were enrolled in this study,and received acetabular replacement with tantalum Jumbo acetabular components. There were 8 males and 10 females,with the mean age of 56. 8 ± 15. 3 years-old（ ranging in 37- 76 years-old）. According to Paprosky classification,the acetabular bone defects were classified into 6 cases of type Ⅱb,7 cases of type Ⅱc,2 cases of type Ⅲa,and 3 cases of type Ⅲb. Data about prosthesis position,stability,bone ingrowth,survivorship,complications,Harris hip score and visual analogous scale（ VAS） were analyzed. Results The mean followup time was 35. 7 months（ ranging in 24- 54 months）. To Paprosky Ⅱ,the Harris hip postoperative score（ 84. 8 ± 11. 8） was significantly higher than the preoperative score（ 48. 3 ± 12. 5）（ t =- 13. 8,P 0. 01）,and the VAS postoperative score（ 1. 1 ± 0. 7） was significantly lower than the preoperative score（ 3. 8 ± 1. 5）（ t = 14. 7,P 0. 01）. To Paprosky Ⅲ,the Harris hip postoperative score（ 77. 8 ± 9. 3） was significantly higher than the preoperative score（ 38. 5 ± 10. 6）（ t =- 16. 4,P 0. 01）,and the VAS postoperative score（ 1. 9 ± 1. 2） was significantly lower than the preoperative score（ 5. 1 ± 1. 6）（ t = 19. 2,P 0. 01）. All the acetabular components were well fixed based on the radiograph imaging results. No one had radiographic evidences of loosening,migration,radiolucent lines and osteolysis. Bone ingrowth was observed in all the patients. One case of dislocation occurred in the fourth week after the operation,and there was no infection or nerve injure. The survivorship of the tantalum Jumbo acetabular components was 100%. Conclusion The porous tantalum Jumbo acetabular component used for revision of acetabular bone defects

关 键 词：髋关节 假体置换 髋臼翻修 骨缺损 Jumbo杯 生物型固定 

分 类 号：R318.08[医药卫生—生物医学工程] R681.6[医药卫生—基础医学]