钽金属骨小梁臼杯结合同种异体骨植骨治疗髋关节翻修术中严重骨缺损  

Trabecular metal cup combined with allograft implantation for severe defects in hip revision arthroplasty

作　　者：黄德勇[1] 张亮[1] 蒋毅[1] 徐辉[1] 李为[1] 李玉军[1] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京西城区新街口东街31号100035

出　　处：《中国矫形外科杂志》2016年第12期1057-1061,共5页Orthopedic Journal of China

摘　　要：[目的]探讨在髋关节翻修术中采用钽金属骨小梁臼杯结合同种异体骨植骨技术治疗髋臼骨缺损的临床疗效。[方法]2008年2月-2012年10月采用钽金属骨小梁臼杯结合同种异体骨植骨治疗44例（44髋）因髋臼无菌性松动或感染后二期翻修合并严重骨缺损和髋臼严重骨溶解的患者,并进行回顾性研究。男23例,女21例,平均年龄58.5岁（34-78岁）。全部患者均采用组配式钽金属臼杯结合同种异体骨植骨重建髋臼骨缺损,其中15例（34%）髋关节的臼杯宿主骨覆盖率不足70%。临床结果采用Harris髋关节评分进行评价。影像学结果依据术后系列X线片进行分析。[结果]平均随访时间53.4个月（30-84个月）,Harris髋关节评分从术前平均20.3分（8-36分）提高至术后最后一次随访的83.8分（39-98分）（P〈0.001）。末次随访时原有3髋的臼杯周围放射性透亮带持续存在,但并无扩大趋势,无新发放射性透亮带出现。术后并发症包括坐骨神经损伤1例、大粗隆不愈合1例。未发现假体无菌性松动患者。[结论]在髋关节翻修术中采用钽金属臼杯结合同种异体骨植骨治疗髋臼骨缺损技术的中期临床和影像学结果令人满意,具有较低的并发症发生率。[Objective]To evaluate the medium- term clinical and radiographic results of tantalum trabecular metal（ TM）acetabular component combined with allograft implantation for acetabular defects in hip revision arthroplasty. [Method]Between Febrary 2008 and October 2012,44 patients（ 44 hips,23 male and 21 female） diagnosed as aseptic loosening,periacetabular bone defect after infection requiring two- stage revision or severe osteolysis,received surgical treatment and were retrospectively reviewed. The average age at revision arthroplasty was 58. 5 years（ range,34- 78 years）. Modular TM- coated acetabular components were inserted combined with extensive allograft impaction in all cases and 15（ 34%） of them had a host bone contact less than 70%. Clinical results were evaluated with Harris hip score and radiographic results were analyzed using postoperative serial X- ray films. [Result]The average duration of follow- up was 53. 4 months（ range,30- 84 months）. The average Harris Hip score increased from preoperative 20. 3 points（ range,8- 36） to 83. 8 points（ range,39- 98） at the last follow- up. At the last follow- up time point,meanwhile,periacetabular radiolucencies were found in 3 hips,which presented at the initial follow- up time point and no new onset periacetabular radiolucencies were detected. Postoperative complications included 1 case of sciatic nerve injury and 1 greater chochanter nonunion. [Conclusion]Tantalum trabecular metal acetabular component combined with allograft implantation,as an proven effective treatment with low complication rate and high level of patients＇ satisfaction,can be a reliable option for reconstruction of acetabular bone defect in revision THA.

关 键 词：钽金属 翻修 同种异体骨植骨 全髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]