全髋关节置换术后髋臼骨缺损翻修的重建技术和临床中期疗效  

The reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty

作　　者：张博涵 付君[2] 张国强[1] 周勇刚[1] 陈继营[1] 柴伟[1] Zhang Bohan;Fu Jun;Zhang Guoqiang;Zhou Yonggang;Chen Jiying;Chai Wei(Senior Department of Orthopaedics,the Forth Medical Center of Chinese People′s Liberation Army General Hospital,National Clinical Research Center for Orthopaedics,Sports Medicine and Rehabilitation,Beijing 100048,China;Department of Orthopaedics,the First Medical Center of Chinese People′s Liberation Army General Hospital,National Clinical Research Center for Orthopaedics,Sports Medicine and Rehabilitation,Beijing 100853,China)

机构地区：[1]国家骨科与运动康复临床医学研究中心,解放军总医院第四医学中心骨科医学部,北京100048 [2]国家骨科与运动康复临床医学研究中心,解放军总医院第一医学中心骨科,北京100853

出　　处：《中华外科杂志》2024年第9期836-846,共11页Chinese Journal of Surgery

基　　金：国家自然科学基金区域联合重点项目(U22A20355);北京市自然科学基金-昌平创新联合基金项目(L234011)。

摘　　要：目的探讨全髋关节置换翻修术中3种髋臼骨缺损重建技术的中期临床疗效。方法本研究为回顾性病例系列研究。回顾性分析2015年1月至2021年12月解放军总医院第四医学中心骨科医学部和解放军总医院第一医学中心骨科收治的全髋关节置换翻修术中行髋臼骨缺损重建的109例(109髋)患者资料。采用术前模拟手术选择适合的骨缺损重建技术,根据重建技术不同,分为多孔金属涂层生物型臼杯(包括超大臼杯)填补髋臼骨缺损组(普通臼杯组)、多孔金属涂层生物型臼杯联合三维打印金属垫块填补髋臼骨缺损组(垫块组)及定制式生物型三翼杯填补髋臼骨缺损组(三翼杯组)。普通臼杯组54例,男性23例,女性31例,年龄(59.6±9.9)岁(范围:32~76岁);垫块组44例,男性18例,女性26例,年龄为(52.8±13.6)岁(范围:17~76岁);三翼杯组11例,男性5例,女性6例,年龄为(59.4±11.2)岁(范围:43~78岁)。患者常规术后3、6、12个月及之后每年于门诊复查,记录患者的髋关节旋转中心高度、旋转中心偏距和双下肢长度差异(LLD),评估Harris髋关节评分(HHS)和疼痛视觉模拟评分(VAS)。末次随访截至2024年3月。手术前后各指标比较采用配对样本t检验。结果所有患者均完成翻修手术并获得2年以上随访。普通臼杯组随访时间为(6.5±1.7)年(范围:2.8~9.3年),垫块组随访时间为(6.0±1.3)年(范围:3.5~9.0年);三翼杯组随访时间为(2.8±0.6)年(范围:2.0~3.8年)。末次随访时,普通臼杯组旋转中心高度、旋转中心偏距和LLD分别为(24.2±5.6)mm、(29.1±5.5)mm、(4.6±3.3)mm,其中旋转中心高度和LLD较术前明显下降,差异均有统计学意义(t=9.671,P<0.01;t=6.073,P<0.01);垫块组旋转中心高度、旋转中心偏距和LLD分别为(22.4±9.0)mm、(25.4±5.5)mm、(6.0±4.0)mm,均较术前减小(t=9.071,P<0.01;t=11.345,P<0.01;t=4.927,P<0.01);三翼杯组旋转中心高度、旋转中心偏距和LLD分别为(22.7±6.0)mm、(30.9±Objective To analyze three reconstruction techniques and mid-term clinical outcomes of hip revision for acetabular bone defect after total hip arthroplasty(THA).Methods This is a retrospective case series study.Included in the study were 109 patients(109 hips)with acetabular bone defect after THA reconstructions in hip revisions from January 2015 to December 2021 in the Senior Department of Orthopaedics,the Forth Medical Center of Chinese People′s Liberation Army General Hospital and the Department of Orthopaedics,the First Medical Center of Chinese People′s Liberation Army General Hospital.According to the preoperative simulated surgeries and different bone defect reconstruction techniques,patients were divided into a normal cup group,an augment group or a triflange group,respectively.There were 54 patients(54 hips)in the normal cup group,reconstructed with the uncemented porous metal cup(including Jumbo cup),with 23 males and 31 females,aged(59.6±9.9)years(range:32 to 76 years);44 patients(44 hips)in the augment group,reconstructed with the individualized three-dimensional(3D)printed porous metal augment and uncemented porous metal cup,with 18 males and 26 females,aged(52.8±13.6)years(range:17 to 76 years);11 patients(11 hips)in the triflange group,reconstructed by the individualized 3D printed porous metal triflange cup,with 5 males and 6 females,aged(59.4±11.2)years(range:43 to 78 years).Radiographic results,including rotation center height,rotation center offset,and leg length discrepancy(LLD)and clinical results,including Harris hip score(HHS)and visual analogue scale(VAS)were evaluated outpatient at 3,6,12 months after the operation and annually thereafter.The last follow-up was completed in March 2024,and all parameters at the last follow-up and before the operation were compared.Paired sample t test and repeated measurement ANOVA were used for the radiographic and clinical parameters before and after the operation.Results All hip revisions for patients with acetabular bone defect after THA were co

关 键 词：关节成形术 置换 髋 髋臼 骨缺损 髋翻修 全髋关节置换术 技术方法 

分 类 号：R687.4[医药卫生—骨科学]