同种异体颗粒骨打压植骨钛网杯重建髋臼骨缺损的疗效  

Titanium wire mesh and impact bone allograft in treating acetabular bone defects in revision total hip arthroplasty

作　　者：陈哲峰 范卫民 王青 崔维顶 刘锋 

机构地区：[1]南京医科大学第一附属医院骨科,210009

出　　处：《中华骨科杂志》2016年第23期1512-1516,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨全髋关节翻修术中应用同种异体打压植骨钛网杯重建髋臼骨缺损的疗效。方法从2008年1月至2012年12月，全髋关节翻修术中应用同种异体打压植骨钛网杯重建髋臼骨缺损22例（22髋）。男7例，女15例；年龄37～78岁，平均64．8岁。Paprosky髋臼骨缺损ⅡA型9例、ⅡB型4例、Ⅱc型7例、ⅢB型2例。20例为假体无菌性松动翻修，2例为假体周围感染的二期翻修。取出松动髋臼假体或骨水泥间隔体，将7～10mm大小的深低温同种异体冷冻松质骨骨粒放置于骨缺损部位，使用打压技术填实；将半径合适的钛网杯以螺钉贴附固定于植骨床及髋臼周边正常骨性结构，聚乙烯臼杯以骨水泥固定。术后1周、3、12个月及以后每年随访一次，采用Harris髋关节评分评价髋关节功能，摄骨盆正位x线片观察髋关节旋转中心的位置、植骨融合情况和臼杯有无松动。结果22例患者术后均获得随访，随访时间3～7年，平均5．1年。术前Harris髋关节评分为（43．75±13．45）分，末次随访时提高至（85．33±7．84）分，差异有统计学意义（t=7．930，P=0．000）。术前患侧髋关节旋转中心高度为（3．49±0．77）cm，对侧为（1．89±0．30）cm，末次随访时患侧旋转中心高度下降至（2．22±0．22）cm，与术前比较差异有统计学意义（t=4．390，P=0．005）。术前髋关节旋转中心至臼底的水平距离（3．54±0．45）cm，对侧为（3．74±0．29）cm，末次随访时患侧旋转中心距离臼底（3．52±0．76）cm，与术前比较差异无统计学意义（t=0．424，P=0．685）。植骨均融合，融合时间为9～15个月，平均12个月。未发现臼杯移位〉4mm或旋转大于5。的病例。术后1例出现坐骨神经牵拉受损症状，无假体相关感染及脱位发生。结论全髋关节翻修术中采用同种异体颗粒打压植骨钛网杯修复髋臼骨缺损能有效重建髋关节旋转中Objective To investigate the method and efficacy in treating acetabular bone defects by the use of titanium wire mesh and impact bone allograft in revision total hip arthroplasty. Methods Twenty-two patients （22 hips） with acetabular bone defects in revision total hip arthroplasty were treated with wire mesh and impact bone allograft from January 2008 to Decem- ber 2013. There were 7 males and 15 females in the present study. The average age of the patients at the surgery was 64.8 （37-78） years, According to Paprosky classification, there were 9 cases of type IIA, 4 cases of IIB, 7 cases of IIC and 2 cases of IIIB. Twen- ty cases with aseptic loosen and 2 with periprosthetic infection were underwent revision surgery. Deep frozen cancellous bone al- lograft was sterilized and morselized to particles with the size of 7 to 10 ram. After removal of loosed acetabular component, the bone grafts were impacted into the acetabular defects area to restore the bone quantity. Titanium wire mesh with appropriate diame- ter was chosen to fix on impacted bone graft and fixed acetabulum with screws. Polyethylene cup was cemented in the mesh wire with proper position. Harris hip score system was used to evaluate the hip joint function. The AP pelvis X-ray was taken at 1 week, 3 months, 12 months and annually thereafter postoperatively to evaluate the rotation center, fusion of the bone graft and loosening of cup. Results All patients were followed up with the average period 5.1 years （3-7 years）. The average Harris hip score before revision was 43.75±13.45, while the score was 85.33±7.84 at last follow-up （t=7.930, P=0.000）. The average height of hip rotation center of surgical side was 3.49±0.77 cm before surgery, while its height at last follow-up was 2.22±0.22 cm （t=4.390, P=0.005）. The distance between hip rotation center and the base of acetabulum was 3.54±0.45 cm before surgery, while its value was 3.52± 0.76 cm at last follow-up. All the bone grafts came to infusion with the average time 12 months

关 键 词：关节成形术 置换 髋 再手术 髋臼 骨移植 移植 同种 外科网 

分 类 号：R687.4[医药卫生—骨科学]