严重髋臼缺损髋关节发育不良患者全髋置换中采用结构性植骨重建髋臼的有效性  

Efficacy of structural bone graft for reconstruction of acetabulum in total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defect

作　　者：杨鉴 梁灿 张会忠 Yang Jian;Liang Can;Zhang Huizhong(Gaozhou City Hospital of Traditional Chinese Medicine,Gaozhou 525200,Guangdong Province,China)

机构地区：[1]高州市中医院

出　　处：《中国组织工程研究》2019年第32期5092-5096,共5页Chinese Journal of Tissue Engineering Research

基　　金：茂名市科技计划项目(170604001705832),项目负责人:杨鉴~~

摘　　要：背景:对于髋臼缺损的患者,全髋置换中可能会因假体覆盖率不足导致安放困难,而结构性植骨重建髋臼可使假体获得覆盖率和稳定性,但如何获得较好的植骨覆盖率是影响疗效的关键。目的:观察严重髋臼缺损的髋关节发育不良患者在全髋置换中采用结构性植骨重建髋臼的有效性,评估植骨覆盖率对修复效果的影响。方法:选取2010年2月至2016年2月高州市中医院骨关节外科收治的80例(100髋)伴有严重髋臼缺损的髋关节发育不良患者作为研究对象,所有患者均行全髋置换,术中以自体股骨头结构性植骨重建髋臼。术后随访期间行骨盆正位X射线检查,并比较患者术前、术后1、2年的Harris评分变化。按入选患者的宿主骨覆盖率进行分组(Ⅰ、Ⅱ和Ⅲ组分别为≥70%、65%-69%、<65%)。结果与结论:(1)术后X射线评估髋臼假体的位置理想,髋臼植骨愈合良好,其中8例植骨块在髋臼假体外缘出现轻度的骨吸收,但在后续随访中未发现假体松动;(2)Harris评分术后1,2年均较术前的评分明显增高(P=0.000);(3)第Ⅰ组宿主骨覆盖率为(73.25±1.40)%,植骨覆盖率为(26.75±0.94)%;宿主骨覆盖率65%-69%者共32例38髋,为第Ⅱ组,宿主骨覆盖率为(67.15±0.57)%,植骨覆盖率为(32.75±0.46)%;<65%者共20例27髋,为第Ⅲ组,宿主骨覆盖率为(55.22±1.10)%,植骨覆盖率为(44.78±0.85)%。术后1,2年,第Ⅰ,Ⅱ组Harris评分无显著差异,第Ⅲ组Harris评分低于第Ⅰ,Ⅱ组(P=0.000);(4)结果证实,对于严重髋臼缺损的髋关节发育不良患者,在全髋置换中采用结构性植骨重建髋臼,可获得较为理想的疗效。试验已于2019-01-12经高州市中医院伦理委员会批准并通过(批准号:GZSZYY83741002)。BACKGROUND:For patients with acetabular defect,it may be difficult to place the prosthesis in total hip replacement because of insufficient coverage.Structural bone graft reconstruction of acetabulum can make the prosthesis achieve coverage and stability,but how to obtain better coverage of bone graft is the key to affect the curative effect.OBJECTIVE:To observe the curative effect of structural bone graft reconstruction for total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defects,and to assess the effect of bone graft coverage on repair.METHODS:Totally 80 patients(100 hips)with severe acetabular defects and hip dysplasia admitted to Department of Bone and Joint Surgery,Gaozhou City Hospital of Traditional Chinese Medicine from February 2010 to February 2016 were selected as the research objects.All patients underwent total hip arthroplasty,with intramedullary reconstruction of the acetabulum with autologous femoral head during operation.The pelvis was examined by X-ray during follow-up.Harris scores were compared between preoperative,postoperative 1 and 2 years.Group allocation was conducted according to graft coverage(≥70%,65%-69%,<65%in the groupsⅠ,ⅡandⅢ,respectively).RESULTS AND CONCLUSION:(1)Postoperative X-ray evaluation showed that the position of acetabular prosthesis was ideal and the healing of acetabular bone graft was good.Among them,8 cases had slight bone resorption at the outer edge of acetabular prosthesis,but no prosthesis loosening was found during follow-up.(2)Harris scores 1 year and 2 years after surgery were significantly higher than those before surgery(P=0.000).(3)Host bone coverage was(73.25±1.40)%,and bone graft coverage was(26.75±0.94)%in theⅠgroup.In theⅡgroup,there were 32 cases(38 hips)with host bone coverage from 65%to 69%;the host bone coverage was(67.15±0.57)%,and bone graft coverage(32.75±0.46)%.In theⅢgroup,there were 20 cases(27 hips)with host bone coverage<65%;the host bone coverage was(55.22±1.10)%,and bone graft

关 键 词：髋关节发育不良 全髋置换 结构性植骨 髋臼 宿主骨覆盖率 植骨覆盖率 X射线 髋臼假体 组织工程 

分 类 号：R459.9[医药卫生—治疗学] R615[医药卫生—临床医学]