采用超大型臼杯生物学固定行臼杯翻修术

Extra-large uncemented acetabular components for revising total hip arthroplasty

目的总结超大型臼杯无骨水泥翻修术治疗臼杯松动合并髋臼骨缺损的早期疗效.方法 11例11髋,均为首次臼杯翻修(RA)术患者.其中臼杯松动合并髋臼骨缺损(Tanzer标准)Ⅰ期者3例,Ⅱ期6例,ⅢA期2例.从全髋关节置换术(THR)至翻修术的时间最短3年,最长13年.全髋置换术的臼杯外径46～50 mm,翻修术的臼杯外径56～60 mm.假体选用AML(Depuy,USA)假体3例,Bi-Metric(Biomet,USA)2例,REF(Lima,Itali)3例,PF(UOC,Taiwan)3例.结果随访2～5年.髋关节功能(Harris标准)从翻修术前的平均30(16～54)分恢复至翻修术后的平均90(85～95)分,其中功能优9例(82%),良2例(18%),无一例需行再翻修.X线片显示:髋关节中心从术前的泪点间线近侧的平均30(17～67) mm改善至翻修术后的平均15(10～20) mm,髋关节旋转中心从泪点外侧的平均23 mm处改善至术后的33 mm,臼杯均表现骨性固定,无一例X线松动.结论对某些类型的臼杯松动骨缺损,采用超大型臼杯行无骨水泥翻修术治疗能够获得满意的临床疗效.

Objective To review early results associated with the use of an extra-large uncemented porous-coated acetabular component for revision in the presence of bone defect.Methods Acetabular loosening associated with bone defect was diagnosed in 11 patients,and revision was the first procedure.Original diagnosis for total hip arthroplasty(THA) included osteoarthritisin in 6 cases,aseptic necrosis of femoral head in 2 cases,giant cell tumor of intertrochanter 1case,femoral neck fracture in 2cases.The severity of bone defect was staged according to Tanzer classification,with a result of stage Ⅰ in 3 cases,stage Ⅱ in 6 cases,stage ⅢA in 2 cases.The THA cup had an outside diameter of 46~50mm,the revision cup had an outside diameter of 56~60mm,which included AML(Depuy,USA)in 3 cases,Bi-Metric(Biomet,USA)in 2 cases,REF(Lima,Itali)in 3 cases and PF(UOC,Taiwan)in 3 cases.Results The mean duration of follow-up was 3 years(2~ 5 years),clinical results were evaluated as excellent in 9 cases(82%),good in 2 cases(18%),the mean modified Harris hip score increased from 30 points preoperatively to 90 points at the time of the most recent follow-up.Up to now,no case needed to perform rerevision.X-ray film revealed that the hip center was a mean of 30mm(17~67mm)proximal to the interteardrop line before revision,and a mean of 15mm(10~20mm) after revision.Before revision,the center of hip rotation was a mean of 23mm lateral to the medial aspect of the teardrop,and after revision it was 33mm lateral to the same landmark,all acetabular cup was categorized as osseousfixation,and no case showed radiolucent line.Conclusion This study confirmed that extra-large uncemented acetabular components for revision in the presence of bone defect have a good cinical results and a low rate of aseptic loosening.