非骨水泥臼杯加自体股骨头植骨全髋关节置换术治疗髋臼发育不良伴骨性关节炎

Total hip arthroplasty with uncemented cup and femoral head autografts for coxarthrosis due to dysplasia

目的 评价非骨水泥臼杯加自体股骨头植骨的全髋关节置换术治疗髋臼发育不良继发骨性关节炎的结果。方法 回顾性分析 2 0例 ( 2 1髋 )患者行全髋关节置换术治疗髋臼发育不良继发骨性关节炎。女性 18例 ,男性 2例 ,平均年龄 5 0岁 ,采用非骨水泥臼杯加自体股骨头植骨螺钉固定重建髋臼侧。臼杯置于真性髋臼水平 ,所有病例由于髋臼缺损而需要行自体股骨头植骨。平均植骨块覆盖的臼杯比例为 31% ( 10 %～ 4 5 % )。 8髋植骨块覆盖小于 2 5 % ,13髋位于 2 5 %～ 5 0 %之间。平均随访时间 4 7年 ( 1 5～ 8年 )。采用改良Harris评分对结果进行评估。术前及随访时进行摄片观察。结果 所有植骨块均获得愈合。无植骨块塌陷和髋假体松动。改良Harris评分由术前平均4 6分增加到 89分。术前除 1例双髋发育不良外 ,下肢不等长均超过 2cm ,术后只有 2例仍有双下肢不等长超过 1cm。 3髋的植骨块外侧非支撑臼杯部分出现轻微的骨吸收。 3髋发现有BrookerⅠ度异位骨化 ,1髋Ⅱ度异位骨化。结论 使用非骨水泥臼杯加自体股骨头植骨重建髋臼侧的全髋关节置换术治疗髋发育不良继发骨性关节炎可获得良好结果。该方法在植骨块支撑臼杯不超过 5 0 %的情况下 ,髋臼固定可靠 。

Objective To evaluate the outcomes of total hip arthroplasty (THA) for coxarthrosis due to dysplasia with acetabular reconstruction of an uncemented cup in conjunction with a femoral head autograft Methods A retrospective study was made on 21 hips in 20 patients (18 female and 2 male; average age,50 years) with developmental hip dysplasia treated by THA with use of an uncemented cup The acetabular cup was placed at the level of the true acetabulum; all patients required autogenous femoral head grafts due to acetabular deficiency The average coverage of the acetabular cup by the femoral head autograft was 31% (range,10% to 45%) Eight hips had less than 25% cup coverage and 13 between 25% and 50% The average follow up period was 4 7 years (range,1 8 years) All patients were evaluated with the use of a modified Harris hip score Radiographic evaluations were made by preoperative and follow up Results All autografts were seen to be united to host bone No collapse of the autograft and no hip had the evidence of loosening of component seen in all patients According to the modified Harris hip score,the average hip score increased from 46 at preoperation to 89 at the final review Preoperative leg length discrepancy was greater than 2 cm seen in all except 1 patient with bilateral hip dysplasia After surgery,only 2 of 20 patients still had a leg length discrepancy greater than 1 cm Three hips showed minor resorption in the lateral portion of the graft which was not supporting the cup Three hips developed grade 1 Brooker heterotopic ossification and one had grade 2 Conclusions THA with an uncemented cup in conjunction with a femoral head autograft for coxarthrosis due to dysplasia could obtain favorable results This method could provide reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia when the coverage of the cementless cup by the graft does not exceed 50%