全髋关节置换术后髋臼缺损的翻修疗效观察  

Clinical outcomes and surgical treatments of bone defects around acetabular cup after total hip arthroplasty

作　　者：许飞[1] 王义生[2] 连鸿凯[1] 蒋振营[1] 

机构地区：[1]河南大学附属郑州市第一人民医院,郑州450054 [2]郑州大学第一附属医院,郑州450052

出　　处：《河南外科学杂志》2016年第3期8-11,共4页Henan Journal of Surgery

摘　　要：目的观察全髋关节置换术后髋臼侧骨缺损的翻修疗效。方法对13例全髋关节置换术后髋臼侧骨缺损的患者实施翻修治疗,回顾性分析患者的影像学特点、临床表现及治疗资料。结果术后平均随访1.8 a。平均Harris评分由术前52分,提高到末次随访时91分。末次随访时13髋均获得良好的稳定性,未出现松动及移位,髋臼周围未见透亮线,假体生存率100%。按照Anderson骨长入影像学评价标准,髋臼杯均出现不同程度骨长入。结论全髋关节置换术后髋臼骨缺损更换较大直径臼杯,选择同种异体颗粒骨结合金属骨小梁模块置入,或髋臼加强杯翻修是解决髋臼侧骨缺损的有效手段,近期疗效好,远期疗效尚待进一步随访。Objective To investigate the diagnosis and surgical treatment strategies of bone defects around the acetabular cup after total hip arthroplasty. Methods From June 2009 to December 2013,13 hips diagnosed bone defects around the acetabular cup after total hip arthroplasty underwent revision surgery were analyzed in clinical and image features. Morcellized allograft bone has been used in parts of hip revision surgery. A total of 2 hips revised with modular metal augments and 2 hips had roof reinforcement rings. Results All cases underwent revision of curettage tissue,the exchange of high- cross- linked polyethylene liner and new femoral head prosthesis with morcellized allogeneic bone grafting. The Harris —score was improved from 52 preoperatively to 91 postoperatively,showing significant difference between pre- operation and post- operation. At the last follow up,13 cases showed good stability,no acetabular cup migration,heterotopic ossification and bright line around acetabular cup occured. The bone graft incorporation scales were Grade Ⅰ and Ⅱ in 8 and 5 cases,respectively. Conclusion It was widely accepted that the acetabular bone defects require use of impacted morcellized allograft bone or structural graft. Impaction grafting with modular metal augments or roof reinforcement ring to bridge segmental defects has also been used effectively. Better quality bone and improved surgical techniques have improved results in patients undergoing these complex reconstructions.

关 键 词：全髋关节置换 髋臼翻修 骨缺损 

分 类 号：R681.6[医药卫生—骨科学]