全髋关节置换术结合自体股骨头骨泥植骨治疗髋臼内陷临床分析  

Clinical Analysis of Acetabular Protrusion Treated by Total Hip Arthroplasty Combined with Autologous Femoral Head Bone Mud Graft

作　　者：毕梦娜[1] 斯焱[1] 陈经勇[1] 李钟[1] 张鹏[1] 陈果 张上上[1] 张占磊 Bi Mengna;Si Yan;Chen Jingyong(Sichuan Orthopaedic Hospital,Chengdu,Sichuan 610000,China.)

机构地区：[1]四川省骨科医院,四川成都610000

出　　处：《四川医学》2021年第10期1031-1036,共6页Sichuan Medical Journal

摘　　要：目的探讨全髋关节置换术结合自体股骨头骨泥植骨治疗髋臼内陷的临床疗效。方法2015年1月至2018年1月我院收治21例(25髋)髋臼内陷患者,根据Sotello-Garza和Charnley分型,Ⅰ型(内陷1~5 mm)2例(2髋),Ⅱ型(内陷6~15 mm)14例(15髋),Ⅲ型(内陷>15 mm)5例(8髋),原发性8例,继发性13例。采用全髋关节置换结合自体股骨头骨泥植骨治疗,Ⅰ型按常规方式脱位并截除股骨头,Ⅱ型、Ⅲ型采取适量截除髋臼后上方骨赘或者股骨颈二次截骨后,取头器取出股骨头。利用自体股骨头,制备骨泥。将骨泥填充、压实于磨锉成形的髋臼,恢复偏心距,增加臼底骨量,利用边缘固定原理放置生物型髋臼杯。采用Harris髋关节评分评估髋关节功能,随访双髋正位片观察假体是否有松动和偏心距恢复程度以及植骨愈合情况。结果本组手术未发生血管、神经损伤以及髋臼和股骨劈裂骨折,术后4个月自体移植骨均与髋臼融合。末次随访的Harris髋关节评分由术前(53±7)分提高至(93±11)分,差异有统计学意义(t=22.79,P<0.01)。股骨头中心点到坐骨结节连线的距离由置换前的(73±13)mm减少到(69±12)mm,差异有统计学意义(t=4.219,P<0.01);股骨头中心到Kohler线的距离由置换前的(10±4)mm增加到置换后的(24±5)mm,差异有统计学意义(t=2.289,P<0.01)。随访期间均无髋臼假体松动发生。结论对髋臼内陷患者采用自体股骨头骨植骨,可增加髋臼底部骨量,同时恢复髋关节旋转中心及偏心距,边缘固定技术可使生物型髋臼杯假体获得可靠的初始稳定性,两者结合,可保证假体的初始、远期稳定性,近中期临床效果满意。Objective To investigate the clinical effect of total hip arthroplasty combined with autologous femoral head bone mud graft in the treatment of acetabular protrusion.Methods From january 2015 to january 2018,twenty-one patients(25hips)with acetabular protrusion were admitted to sichuan orthopaedic hospital. According to Sotello-Garza and Charnley classification,2 cases(2 hips)were type Ⅰ(protrusio acetabuli 1~5 mm),14 cases(15 hips)were type Ⅱ(6~15 mm),and 5 cases(8 hips)were type Ⅲ(protrusio acetabuli>15 mm),Primary:8 cases,Secondary:13 cases.All cases were treated with total hip arthroplasty combined with autologous femoral head bone mud bone grafting.The posterolateral approach was used for the operation,and the femoral head was dislocated and amputated in a conventional way for type I.For type II or III,after an appropriate amount of osteophytes above the posterior acetabulum or femoral neck of secondary osteotomy,the femoral heads were moved out with retrograde method.A small reamer reams femoral head for the preparation of bone mud.Autolgous-bone grafting was used to repair acetabular defects and biological acetabular cups were planted with press-fit skills.The range of motion and the Harris scores were used to evaluate the clinical efficacy.The preoperative and postoperative data of Harris hip score and the distance between the center of femoral head to Kohler line or two tuberosities were analyzed by paired t test. Results After surgery,vascular and nerve injury and split fractures of the acetabulum and femur did not occur,and autologous grafts were fused with the acetabulum 4 months after surgery.At the last follow-up,the average Harris hip score improved from(53±7)points preoperatively to(93±11)points post-operatively( t =22.79, P <0.01),demonstrating that the difference was statistically significant.The distance between the center of femoral head and two ischial tuberosities was reduced from(73±13)mm preoperatively to(69±12)mm post-operatively,indicating a statistically significant difference

关 键 词：髋臼内陷 全髋关节置换 骨移植 

分 类 号：R684.2[医药卫生—骨科学]