打压自体植骨全髋关节置换治疗强直性脊柱炎髋臼内陷  

Impaction bone autografting in total hip arthroplasty for acetabular protrusion secondary to ankylosing spondylitis

作　　者：王业鑫 戴志刚[1] 张海妮 冯磊[1] 刘儒森[1] WANG Ye-xin;DAI Zhi-gang;ZHANG Hai-ni;FENG Lei;LIU Ru-sen(The First Department of Joint Surgery,The Afiliated Hospital,Weifang Medical University,Weifang 261031,China)

机构地区：[1]潍坊医学院附属医院关节外一科,山东潍坊261031

出　　处：《中国矫形外科杂志》2020年第23期2183-2186,共4页Orthopedic Journal of China

摘　　要：[目的]介绍打压自体植骨全髋关节置换术治疗强直性脊柱炎继发髋臼内陷的手术技术和初步临床效果。[方法] 2013年12月~2018年12月本科收治强直性脊柱炎继发中度髋臼内陷的患者10例(15髋),15髋均采用自体骨打压植骨全髋关节置换治疗。清除髋臼内软组织,依次使用不同型号髋臼锉打磨髋臼。咬骨钳咬除股骨头表面的软骨,制作成松质骨条,植入髋臼内上方凹陷处,打入器轻轻将松质骨条打实,然后髋臼锉反转,髋臼底成形。然后根据髋臼大小,选择合适的髋臼杯。[结果]所有患者均获得随访,随访时间24~72个月,平均(46.27±17.92)个月。至末次随访时,髋关节Harris评分由术前(37.27±4.64)分提高到术后(86.93±4.25)分,髋臼内缘到Kohler’s线的距离由术前(12.40±1.55) mm减少至术后(0.73±1.87) mm。随访期间复查X线片显示假体均无松动、下沉,无髋臼再次内陷。[结论]针对强直性脊柱炎继发中度髋臼内陷患者,采用全髋关节置换术联合自体骨加压植骨治疗,术后能够有效恢复髋臼骨量,纠正髋臼内陷,近期临床效果满意。[Objective] To introduce surgical technique and primary clinical outcomes of impaction bone autografting in total hip arthroplasty for acetabular protrusion secondary to ankylosing spondylitis. [Methods] Between December 2013 and December 2018, 10 patients(15 hips) underwent impaction bone autografting in total hip arthroplasty for acetabular protrusion secondary to ankylosing spondylitis in our department. After soft tissue removed, the acetabulum was reamed gradually to the real bone with hemorrhage. Granular bone grafts made of the autological femoral head were filled into the acetabulum, impacted and trimmed by reverse reaming to correct the acetabular protrusion. After that, a cementless acetabular component in proper size was inserted firmly by press-fit. [Results] All patients were followed up for 24~72 months with an average of(46.27±17.92)months. Harris score significantly increased from(37.27±4.64) preoperatively to(86.93±4.25) at latest the follow up, whereas the distance from the acetabular dome to Kohler’s line decreased from(12.40±1.55) mm preoperatively to(0.73±1.87) mm at the latest interview. During the follow up period, X-ray films revealed no loosening or subsidence of acetabular component, or recurrence of acetabular protrusion happened in anyone of them. [Conclusion] This impaction bone autografting in total hip arthroplasty does restore acetabular bone stock, and correct acetabular protrusion effectively, achieves satisfactory clinical outcome for acetabular protrusion subsequent to ankylosing spondylitis.

关 键 词：全髋关节置换 强直性脊柱炎 髋臼内陷 植骨 

分 类 号：R687.4[医药卫生—骨科学]