计算机辅助定制cage及同种异体颗粒骨植骨重建严重髋臼骨缺损的疗效  

Using customized acetabular cages for revision THA with severe bone defects

作　　者：李慧武[1] 朱振安[1] 徐辰[1] 徐嘉炜[1] 毛远青[1] 曲新华[1] 张经纬[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,200011

出　　处：《中华骨科杂志》2016年第23期1487-1494,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81672181）;上海市自然科学基金（15ZR1424800）;教育部留学回国人员科研启动基金（201550002）

摘　　要：目的探讨全髋关节翻修术中计算机辅助定制cage重建严重髋臼骨缺损的临床疗效。方法2005年1月至2014年9月因全髋关节置换术后严重髋臼骨缺损行计算机辅助定制cage重建23例（23髋），男8例，女15例；年龄46～79岁，平均64．2岁。骨缺损AAOS分类：Ⅲ型20例，Ⅳ型3例。采用计算机辅助定制技术根据髋臼骨缺损形态设计并制作cage，植入cage及同种异体颗粒骨植骨重建髋臼骨缺损。术后6周、12周、1年及以后每年随访一次，对Harris髋关节评分、术后并发症和再手术率进行评估。放射学评价包括cage位置、移位和植骨愈合情况。结果随访24～120个月，平均66．3个月。Harris髋关节评分从术前（36．2±7．9）分（20±49分）提高至末次随访的（81．8±8．4）分（60～96分），差异有统计学意义（t=23．23，P〈0．001）。定制cage翻修术后髋关节旋转中心基本位于解剖位置。翻修侧髋关节旋转中心水平距离（股骨头中心距耻骨联合的水平距离）与健侧相差（-3．0±6．4）mm（-19～8mm），垂直距离（股骨头中心距双侧泪滴下缘连线的距离）与健侧相差（0．4±2．8）mm（-4．5～5mm）。随访期间无再次翻修病例。x线片未见cage移位，1例可见假体周围2mm环形透光线。22例同种异体颗粒骨骨整合良好，1例可见较明显的骨吸收。术后发生深部感染1例、浅表感染1例，予以冲洗、清创及负压封闭引流治疗；术后脱位1例、可疑臀上神经损伤1例，均予以保守治疗。结论应用计算机辅助定制cage翻修严重髋臼骨缺损，可重建髋关节旋转中心，改善髋关节功能，翻修假体松动率低，近中期疗效满意。Objective To evaluate the results of computer-aid customized acetabular cages for patients with severe defects. Methods Twenty-three patients （8 males and 15 females） with a massive acetabular defects were involved in the present study from January 2005 to September 2014. The average age was 64.2 years （range, 46-79 years）. According to the American Academy of Orthopaedic Surgeons （AAOS） classification, 20 had AAOS type Ⅲ defects and three had AAOS type Ⅳ defects. The customized cages were individualized to each patient＇s bone defects based on the rapid prototype three-dimensional printed models. The mean follow-up duration was 66.3 months （range, 24-120 months）. The clinical and radiographic outcomes of all patients were assessed at 6 and 12 weeks after surgery and at once yearly thereafter. Harris hip scores were assessed before surgery and at each follow-up. Postoperative radiographs were evaluated for cage position, migration, and graft incorporation. Complications and reoperations were assessed by chart review. Results The mean Harris hip score improved from 36.2±7.9 （range, 20-49） to 81.8±8.4 （range, 60-96）, and there is a significant difference between pre- and post-operation （t=23.23, P〈0.001）. Individualized cus- tom cages resulted in generally reliable restoration of the hip center. The difference of horizontal distance （between the center of each hip and pubic symphysis） between bilateral sides was -3.0±6.4 mm （range,- 19-8 mm）. The difference of vertical distance （between the center of each hip and the line connecting the inferior border of the bilateral tear drop） between bilateral sides was 0.4＋2.8 mm （range, -4.5-5 mm）. No re-revisions had been conducted. None of the cups showed radiographic migration, while one cage was suspected to be loose based on a circumferential 2-mm radiolucent line. Cancellous allografts appeared to be incorporat- ed in 22 of 23 patients. One deep infection and one superficial infection were observed and were treated

关 键 词：关节成形术 置换 髋 骨质溶解 再手术 髋假体 骨移植 

分 类 号：R687.4[医药卫生—骨科学]