采用金属重建杯行髋关节翻修术的临床疗效

Effectiveness of acetabular revision using a metal reconstruction cage

目的探讨采用金属重建杯行髋关节翻修术的临床疗效。方法回顾分析2006年10月—2013年10月,采用金属重建杯行髋关节翻修术的16例(16髋)患者临床资料。男4例,女12例;年龄49~78岁,平均62.7岁。初次人工全髋关节置换术至该次翻修术时间为3~15年,中位时间8.2年。翻修原因:假体无菌性松动15例,Vancouver B3型股骨柄假体周围骨折1例。髋臼侧骨缺损根据美国骨科医师协会(AAOS)分型:Ⅲ型12例,Ⅳ型4例;Paprosky分型:ⅢA型12例,ⅢB型4例。采用Harris评分评价髋关节功能,疼痛视觉模拟评分(VAS)评价术后大腿疼痛情况;摄X线片行影像学评价。结果术后患者切口均Ⅰ期愈合;1例于术后2周发生下肢深静脉血栓形成,行抗凝治疗后治愈;无感染、神经血管损伤及脱位等并发症发生。16例均获随访,随访时间2~9年,平均6.8年。末次随访时Harris评分为(91.88±3.28)分,较术前(42.44±4.66)分显著改善(t=–106.30,P=0.00)。2例术后下地行走时出现轻度大腿痛,症状于术后1年消失。术后即刻髋臼外展角为37~54°,平均42.9°;髋关节旋转中心距泪滴间线距离和距泪滴外侧距离分别由术前的(33.67±12.19)mm和(34.98±12.30)mm改善至术后即刻的(20.67±9.63)mm和(40.04±6.61)mm,比较差异均有统计学意义(t=–9.60,P=0.00;t=–3.15,P=0.00)。术后4~12个月X线片示所有股骨大转子延长截骨区均获骨性愈合,随访期间金属重建杯与骨面均无连续性透亮带,无假体移位及骨溶解,臼杯均呈骨性固定;无1例因假体松动需行再翻修手术者。结论对于臼杯假体松动合并髋臼骨缺损者,采用金属重建杯行翻修术可获得较好疗效。

Objective To explore the clinical outcomes of acetabular revision using a metal reconstruction cage. Methods Between October 2006 and October 2013, 16 patients （16 hips） underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years （range, 49-78 years）. The time from total hip arthroplasty to revision was 3-15 years （mean, 8.2 years）. The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture （Vancouver type B3） in 1 case. According to the American Academy of Orthopaedic Surgeons （AAOS） classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale （VAS） for pain in the thigh. X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average （range, 2-9 years）. The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up （t=-106.30, P=0.00）. Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° （mean, 42.9°）. The distance between acetabular rotation centre and teardrop line was （33.67±12.19） mm for preoperative value and was （20.67±9.63） mm for postoperative value, showing significant difference （t=-9.60, P=0.00）.The distance between acetabular rotation centre and lateral teardrop was （34.98±12.30） mm for preoperative value and was （40.04±6.61） mm for postoperative value, showing significant difference （t=-3.15, P=0.00）. X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. Conclusion The metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.