髋关节翻修术中应用Cup-in-Cup技术重建PaproskyⅢ型髋臼骨缺损的早期疗效  

The early effects of revision hip arthroplasty for reconstruction of Paprosky typeⅢacetabular defect using Cup-in-Cup technology

作　　者：臧加成[1] 赵秀祥[1] 马信龙[1] 张银光[1] Zang Jiacheng;Zhao Xiuxiang;Ma Xinlong;Zhang Yinguang

机构地区：[1]天津市天津医院髋关节外科,天津300211

出　　处：《中华骨科杂志》2022年第9期579-586,共8页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康委员会中医中西医结合科研项目(2021157);天津市卫生健康委员会科技项目(ZC20053,ZC20209)。

摘　　要：目的探讨髋关节翻修术中采用Cup-in-Cup技术重建PaproskyⅢ型髋臼骨缺损的早期疗效。方法2017年1月至2019年12月采用Cup-in-Cup技术重建PaproskyⅢ型髋臼骨缺损20例(20髋),男9例、女11例;年龄(64.6±9.8)岁(范围45~76岁)。翻修原因为假体无菌性松动17例、假体周围感染导致假体松动3例;PaproskyⅢA型髋臼骨缺损13例、PaproskyⅢB型7例。采用单纯髋臼侧翻修13例,髋臼和股骨侧同时翻修7例。术后随访时评估Harris髋关节评分,统计术中血管、神经损伤和术后假体脱位、假体周围感染及骨折等严重并发症的发生情况,通过X线片测量髋关节旋转中心高度和水平位置。结果翻修手术时间为(110±25)min(范围80~180 min);术中出血量为(700±180)ml(范围500~1600 ml)。20例均获得随访,随访时间12~36个月,平均18个月。末次随访时16例Harris髋关节评分在80分以上,2例评分为优、14例为良、4例为可;Harris评分为(84.3±7.5)分,较术前的(40.1±16.6)分提高,差异有统计学意义(t=15.34,P<0.001)。末次随访时患侧髋关节旋转中心高度由术前(34.2±3.3)mm降低至(18.6±2.8)mm,差异有统计学意义(t=15.11,P<0.001);水平距离由术前(18.1±5.5)mm增加至(26.2±7.3)mm,差异有统计学意义(t=-5.95,P<0.001);术后患侧髋关节旋转中心高度较对侧[(12.2±3.3)mm]轻度上移,差异有统计学意义(t=6.73,P=0.018);水平位置为(26.2±7.3)mm,与对侧(30.1±5.5)mm比较差异无统计学意义(t=-3.29,P=0.381)。无一例出现血管、神经损伤、假体周围感染及切口相关并发症。随访期间假体位置良好,无假体松动及螺钉松动、断裂。结论髋关节翻修术中采用Cup-in-Cup技术重建PaproskyⅢ型髋臼骨缺损能获得较好的早期疗效,重建相对正常的髋关节旋转中心,假体初始稳定性和早期稳定性良好。Objective To investigate the early effects of cup in cup technique in reconstructing paprosky III acetabular bone defect in revision hip arthroplasty.Methods From January 2017 to December 2019,a total of 20 cases(20 hips)with paproskyⅢacetabular bone defect were reconstructed by Cup-in-Cup technique,including 9 males and 11 females.The age ranged from 45 to 76 years,with an average of 64.6 years.The causes of revision were aseptic loosening of prosthesis in 17 cases and loosening of prosthesis caused by periprosthetic infection in 3 cases.There were 13 hips with acetabular bone defect of paproskyⅢA and 7 hips with paprosky IIIB.The acetabular side was repaired in 13 cases,and the acetabulum and femoral side were repaired in 7 cases at the same time.Harris hip score was used to evaluate hip function during postoperative follow-up.The occurrence of serious complications such as intraoperative vascular and nerve injury,postoperative prosthesis dislocation,periprosthetic infection and fracture were counted.The height and horizontal position of hip rotation center were measured by X-ray film.Results The operation duration was 110±25 min(range 80-180 min)and intraoperative bleeding was 700±180 ml.All cases were followed up for 12-36 months,with an average of 18 months.At the last follow-up,the Harris hip score of 16 cases was more than 80,with excellen in 2 cases,good in 14 cases and fair in 4 cases.The Harris score was 84.3±7.5,which was significantly higher than that before operation 40.1±16.6(t=15.34,P<0.001).The height of hip joint rotation center on the affected side decreased from 34.2±3.3 mm before operation to 18.6±2.8 mm after operation with significant difference(t=15.11,P<0.001).The horizontal distance increased from 18.1±5.5 mm before operation to 26.2±7.3 mm after operation with significant difference(t=-5.95,P<0.001).After operation,the height of hip joint rotation center on the affected side was slightly higher than that on the opposite side,with a significant difference between the affected

关 键 词：关节成形术 置换 髋 再手术 髋臼 

分 类 号：R687.4[医药卫生—骨科学]