髋关节翻修金属垫块与颗粒植骨治疗髋臼内上方骨缺损的疗效分析  

The therapeutic effect between metal augment and impacted bone grafting in the hip revision of acetabular bone defect

作　　者：陈湛杰 张雷[1] 丁长年 周利武[1] 郭亭[1] 包倪荣[1] 王北岳[1] 赵建宁[1] CHEN Zhan-jie;ZHANG Lei;DING Chang-nian;ZHOU Li-wu;GUO Tin;BAO Ni-rong;WANG Bei-yu;ZHAO Jian-ning(Department of Orthopedics,Jinling Hospital,Nanjing University School of Medicine/Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,China;Department of Orthopedics,China Coal Construction Group General Hospital,Suzhou 234000,Anhui,China)

机构地区：[1]南京军区南京总医院骨科,南京210002 [2]安徽省宿州市中煤矿建总医院骨科

出　　处：《医学研究生学报》2018年第4期373-376,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(８１７０２１７０)；江苏省自然科学基金(ＢＫ２０１７０６２４)；中国博士后科学基金(２０１７Ｔ１００８２６)

摘　　要：目的近年来髋关节翻修金属垫块系统治疗骨缺损取得了显著成效,但与传统方式对比研究较少。文中旨在探讨髋关节翻修金属垫块与颗粒植骨治疗髋臼内上方骨缺损的疗效。方法回顾性分析2010年8月至2017年2月南京军区南京总医院骨科20例(20髋)人工髋关节置换术后髋臼骨缺损患者资料。将本组患者分为颗粒植骨组(n=11,采用髂前上棘松质骨和人工骨填充髋臼骨缺损)和金属垫块组(n=9,采用金属垫块填充髋臼骨缺损),统计分析2组患者手术时间、术中出血量、髋关节功能评分(HSS)及采用Harris髋关节评分,对比评价2组患者改善情况,及恢复完全负重时间。结果颗粒植骨组手术时间[(44.5±7.82)min]及术中出血量[(431.82±57.76)m L]较金属垫块组[(36.22±5.19)min、(333.33±72.80)m L]明显延长(P<0.05)。颗粒植骨组患者3例在Ⅰ区术后出现轻度骨吸收,金属垫块组仅1例在Ⅱ区出现轻度骨吸收。金属垫块组术后2周、3个月、6个月HSS评分[(43.89±2.76)、(49.89±2.03)、(53.44±2.46)分]显著高于颗粒植骨组[(40.82±4.42)、(45.27±3.90)、(50.55±3.67)分],差异有统计学意义(P<0.001)。金属垫块组在术后3个月、6个月Harris评分显著高于颗粒植骨组(P<0.01)。金属垫块组完全负重时间[(9.33±2.83)周]较颗粒植骨组[(17.27±4.22)周]明显缩短(P<0.01)。结论对于髋臼内上方骨缺损患者,采用金属垫块行翻修术可以节约手术时间,在早期假体稳定性,骨长入方面优于颗粒植骨,可缩短了术后下地时间,促进功能恢复。Objective The application of metal augments in the revision of total hip arthroplasty(THA)has achieved remarkable results in the treatment of bone defects.However,there are limited studies compared this effective method with the traditional treatment.The purpose of this article is to investigate the curative effect of both metal augmentation and impacted bone grafting in the revision of acetabular bone defect.Methods We retrospectively analyzed 20 patients(20 hips)with bone defects after THA in Authority of Nanjing General Hospital of Nanjing Military Region from August 2010 to February 2017.These 20 patients were allocated into 2 groups:impacted bone grafting group(n=11,filling acetabular bone defect with autogenous iliac bone and artificial bone)and metal augmentation group(n=9,filling acetabular bone defect with metal augment).The duration of surgery,blood loss and the hospital for special surgery knee score(HSS)were compared between these two groups and the Harris score was applied to evaluate the hip function and full weight bearing.Results The surgery duration and blood loss of impacted bone grafting group were significantly increased when compared with the metal augmentation group(44.5±7.82 min vs 36.22±5.19 min and 431.82±57.76 mL vs 333.33±72.80 mL respectively).there were 3 cases showed mild bone resorption in the I regions in the impacted bone grafting group,while only one case showed mild bone resorption in the II region in the metal augmentation group.The HSS scores in the metal augmentation group were higher than those in the impacted bone grafting group at the time of postoperative 2 weeks(43.89±2.76 vs 40.82±4.42),3 months(49.89±2.03 vs 45.27±3.90)and 6 months(53.44±2.46 vs 50.55±3.67),the differences were statistically significant(P<0.001).The Harris scores in the metal augmentation group were higher than those in the impacted bone grafting group(P<0.01).The metal augmentation group had a shorter time of getting out of bed compared with the impacted bone grafting group(P<0.01).Conclusio

关 键 词：髋臼骨缺损 颗粒植骨 金属垫块 人工髋关节置换术 髋臼假体翻修 HARRIS评分 HSS评分 

分 类 号：R687.4[医药卫生—骨科学]