结构性植骨应用于PaproskyⅢA型髋臼骨缺损髋关节翻修  

Structural bone grafting in revision total hip arthroplasty with PaproskyⅢA acetabular defect

作　　者：许志庆 庄至坤 龚志兵 吴荣凯 林行会 吴昭克 Xu Zhiqing;Zhuang Zhikun;Gong Zhibing;Wu Rongkai;Lin Hanghui;Wu Zhaoke(Department of Orthopedics,Quanzhou Orthopedic-Traumatological Hospital of Fujian,Quanzhou 362000,Fujian Province,China)

机构地区：[1]福建省泉州市正骨医院关节外科,福建省泉州市362000

出　　处：《中国组织工程研究》2021年第36期5787-5791,共5页Chinese Journal of Tissue Engineering Research

基　　金：福建省泉州市正骨医院给予研究大力支持与帮助。

摘　　要：背景:合并髋臼侧严重骨缺损的人工全髋关节翻修会出现假体安放困难、初始稳定性差、术后假体松动等问题,是关节外科医生面临的复杂且具有技术挑战的一大难题。目的:观察同种异体股骨头结构性植骨应用于PaproskyⅢA型髋臼骨缺损髋关节翻修的临床疗效。方法:回顾分析2010年1月至2018年1月福建省泉州市正骨医院收治的15例(15髋)伴有PaproskyⅢA型髋臼骨缺损的髋关节翻修患者,所有患者术中采用同种异体股骨头结构性植骨重建髋臼,术后均严格按照康复计划负重行走。术后7 d、6个月、1年及随后每年定期复查双髋正位、患髋侧位X射线片;评估髋臼杯覆盖率与植骨块覆盖率、髋关节旋转中心水平位移和垂直位移、植骨块愈合与吸收、髋臼杯的骨长入与松动、髋臼杯周围骨溶解、髋关节Harris评分等指标。结果与结论:(1)所有患者随访时间2.5-10.0年;末次随访时髋关节Harris评分为(83.2±5.8)分,与术前(25.3±5.3)分比较,差异有显著性意义(t=28.739,P=0.000);(2)术后7 d髋臼杯覆盖率为91.7%-100%,平均(95.6±2.2)%;术后7 d植骨块覆盖率为21.5%-53.2%,平均(37.4±10.0)%;(3)术后7 d髋关节旋转中心水平位移为(5.8±1.7)mm,与术前(8.2±3.9)mm比较,差异有显著性意义(t=-2.128,P=0.042);术后7 d髋关节旋转中心垂直位移为(4.8±2.1)mm,与术前(22.2±4.2)mm比较,差异有显著性意义(t=-14.321,P=0.000);(4)术后6个月至1年4例(4髋)出现异体股骨头轻度吸收现象,吸收均位于外侧无应力分布区域,均未影响髋臼杯稳定;15例(15髋)异体股骨头与髋臼骨交界均有骨小梁连接;末次随访时异体股骨头与髋臼骨均呈骨性愈合,无不愈合现象;(5)15例(15髋)末次随访时髋臼杯均已获骨长入,而无假体松动表现,髋臼杯周围均无明显骨溶解表现;所有患者术后均未发生深静脉血栓、感染、神经损伤、脱位等并发症;(6)提示同种异体股骨头结构性植�BACKGROUND:Revision total hip arthroplasty with serious bone defect of acetabulum is complicated problem with technical challenges to joint surgeons,because of prosthetic installation difficulties,poor initial stability,postoperative prosthesis loosening.OBJECTIVE:To evaluate the effectiveness of structural bone grafting in revision total hip arthroplasty with PaproskyⅢA acetabular defect.METHODS:Between January 2010 and January 2018,15 patients(15 hips)with PaproskyⅢA acetabular defect underwent revision total hip arthroplasty by structural bone grafting.All patients underwent revision total hip arthroplasty,with intramedullary reconstruction of the acetabulum with allogeneic femoral head during operation and weight-bearing walking in strict accordance with the rehabilitation program after operation.Standardized hip radiographs were assessed postoperatively 7 days,and at 6 months,1 year and annually thereafter.The following outcomes were assessed:acetabulum cup coverage,bone graft coverage,the height and horizontal distance of center of hip rotation,bone graft healing and absorption,bone ingrowth,cup loosening,periprosthetic osteolysis,and Harris hip score.RESULTS AND CONCLUSION:(1)All patients were followed up for 2.5-10.0 years.The Harris score of the hip joint at the last follow-up was(83.2±5.8)points;compared with the preoperative data(25.3±5.3)points,the difference was significant(t=28.739,P=0.000).(2)The coverage rate of the acetabular cup was 91.7%-100%at postoperative 7 days,with an average of(95.6±2.2)%.The coverage rate of the bone graft at postoperative 7 days was 21.5%-53.2%,with an average of(37.4±10.0)%.(3)The horizontal displacement of the hip joint rotation center at postoperative 7 days was(5.8±1.7)mm;compared with the preoperative data(8.2±3.9)mm,the difference was significant(t=-2.128,P=0.042).At postoperative 7 days,vertical displacement of the center of rotation was(4.8±2.1)mm;compared with(22.2±4.2)mm before operation,the difference was significant(t=-14.321,P=0.000).(4)From 6 m

关 键 词：同种异体股骨头 结构性植骨 PaproskyⅢA型 髋臼骨缺损 髋关节翻修 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]