双球面填充块在髋臼骨缺损重建中的临床效果分析  

The application and effect of bispherical augment in acetabular defects reconstruction

作　　者：李国远 张晓琪 陈敏 罗正亮 付代杰 纪小枫 倪喆 尚希福 Li Guoyuan;Zhang Xiaoqi;Chen Min;Luo Zhengliang;Fu Daijie;Ji Xiaofeng;Ni Zhe;Shang Xifu(Department of Orthopaedics,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Division of Life Science and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)骨科,中国科学技术大学生命科学与医学部,合肥230001

出　　处：《中华外科杂志》2024年第9期828-835,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(81902201);安徽省自然科学基金(2308085MH2512);中国科学技术大学附属第一医院(安徽省立医院)医学人工智能联合基金(MAI2023Q027);合肥综合性国家科学中心大健康研究院先导医学与前沿技术研究所项目(2023IHM01075)。

摘　　要：目的探讨髋关节翻修术中应用双球面填充块重建髋臼骨缺损的临床疗效。方法本研究为回顾性病例系列研究。回顾性分析2019年1月至2023年12月于中国科学技术大学附属第一医院骨科接受髋关节翻修术,并采用双球面填充块重建髋臼骨缺损的119例(124髋)患者的临床资料。男性57例(58髋),女性62例(66髋);年龄(65.0±11.8)岁(范围:40~102岁);体重指数(23.9±3.5)kg/m^(2)(范围:16.1~32.2 kg/m^(2))。髋臼周围骨缺损Paprosky分型ⅡA型2髋,ⅡB型29髋,ⅡC型34髋,ⅢA型31髋,ⅢB型28髋。9例(9髋)合并骨盆不连续。手术前后拍摄X线片测量髋关节旋转中心高度、旋转中心至泪滴的水平距离,观察假体影像学稳定性,记录术后并发症等情况。比较术前及末次随访时Harris髋关节评分(HHS)、双下肢长度差异等。数据比较采用配对样本t检验。结果所有患者均顺利完成手术。手术时间(167.0±53.4)min(范围:90~380 min)。术中出血量(345.3±124.2)ml(范围:100~1200 ml)。髋关节旋转中心高度由术前的(39.7±13.0)mm降至术后的(21.8±7.1)mm,旋转中心至泪滴的水平距离由术前的(34.0±10.6)mm提高至术后的(38.5±5.9)mm,差异均有统计学意义(t=15.859,P<0.01;t=5.266,P<0.01)。随访时间(26.1±15.4)个月(范围:6~60个月)。末次随访时,HHS由术前的(35.2±10.0)分提高至(85.5±9.5)分,差异有统计学意义(t=50.723,P<0.01)。双下肢长度差异由术前的(2.1±1.1)cm降至(0.5±0.5)cm,差异有统计学意义(t=13.767,P<0.01)。随访期间所有患者的髋臼组件在影像学上均稳定、无移位。3例患者出现髋关节脱位,经闭合复位后随访期间假体在位良好。其他患者无脱位、松动、骨折、感染复发及血管神经损伤等并发症发生。结论双球面填充块可有效重建髋臼骨缺损,恢复髋关节旋转中心,改善髋关节功能,近中期疗效满意。Objective To evaluate the clinical effect of bispherical augment in acetabular defects reconstruction in hip revision.Methods This is a retrospective case series study.A retrospective analysis of 119 patients(124 hips)patients who underwent hip revision surgery and reconstructed with bispherical augment for acetabular bone defects from January 2019 to December 2023 was performed.There were 57 males(58 hips)and 62 females(66 hips),aged(65.0±11.8)years(range:40 to 102 years).The body mass index was(23.9±3.5)kg/m^(2)(range:16.1 to 32.2 kg/m^(2)).Acetabular bone defects were typed as follows:2 hips in Paprosky typeⅡA,29 hips in typeⅡB,34 hips in typeⅡC,31 hips in typeⅢA,and 28 hips in typeⅢB,of which 9 patients(9 hips)were combined with pelvic discontinuity.Differences in Harris hip score(HHS)and lower limb discrepancy(LLD)were compared between preoperatively and final follow-up.The height of the hip center of rotation and the horizontal distance from the center of rotation to the teardrop were measured by radiographs before and after surgery,and prothesis stability and the occurrence of postoperative complications were evaluated.Data were compared using the paired sample t test.Results All patients successfully completed the operation.The operation time was(167.0±53.4)minutes(range:90 to 380 minutes)and the intraoperative bleeding was(345.3±124.2)ml(range:100 to 1200 ml).The height of the hip center of rotation decreased from(39.7±13.0)mm preoperatively to(21.8±7.1)mm postoperatively and the horizontal distance from the center of rotation to the teardrop increased from(34.0±10.1)mm preoperatively to(38.5±5.9)mm postoperatively,and the differences were statistically significant(t=15.859,P<0.01;t=5.266,P<0.01).All the patients were followed up for(26.1±15.4)months(range:6 to 60 months).At the last follow-up,HHS improved from(35.2±10.0)points preoperatively to(85.5±9.5)points,and the difference was statistically significant(t=50.723,P<0.01).LLD decreased from(2.1±1.1)cm preoperatively to(0.5±0.5)

关 键 词：关节成形术 置换 髋 髋臼 髋关节翻修术 髋臼骨缺损 骨重建 

分 类 号：R687.4[医药卫生—骨科学]