结构性植骨重建髋臼上外侧壁骨缺损的疗效

Effect of using Structural Bone Graft in Acetabular Superior Lateral Wall Defect

目的:探讨结构性植骨重建髋臼上外侧壁骨缺损的疗效。方法:患者共59例61髋,自体骨植骨43髋、异体骨植骨15髋、自体骨与异体骨混合植骨3髋。骨缺损最大62mm×33mm×26mm,最小31mm×19mm×18mm,平均41mm×23mm×21mm。全部采用非骨水泥髋臼假体。临床评价采用Harris评分,X线观察移植骨愈合和髋臼假体的稳定情况等。结果:平均随访时间为10.1a,本组Harris评分平均从61分提高到89分,所有病例髋臼假体稳定,移植骨愈合。X线片显示移植骨愈合时间平均为6.9个月,出现移植骨轻度和中度吸收18髋,对髋臼假体的覆盖和稳定性无明显影响。本组术后翻修6髋,其原因为骨溶解2髋,聚乙烯髋臼衬垫磨损和脱位4髋。结论:采用自体骨、异体骨或混合骨进行结构性植骨重建髋臼上外侧壁骨缺损,经过中长期随访,移植骨全部愈合良好,获得满意的疗效;32.8%病例出现轻、中度的骨吸收,但对髋臼假体的稳定性无明显影响。

Objective：To analyze the result of using Structural Bone Graft in acetabular lateral wall defect. Methods： There are 59 patients and 61 hips,21 male and 38 female cases, with an average age of 39. Grafted bones were autogenous in 43 hips, allograft in 15 hips, and combined bone graft in 3 hips. The largest bone defect is 62mm × 33mm× 26mm, the smallest is 3 1mm ×19mm× 18mm, the average is 41 mm× 23mm ×21 mm. Cementless acetabular prostheses were used in all cases. Clinical evaluation was performed with Harris hip score, and the situations of union of grafted bones and prostheszs stability, were observed by nadiography. Results：The average follow-up period was 10.1 years. Harris hip score was improved from 61 points preoperatively to 89 points postoperatively. All the prostheses were stable and grafted bone united. The average union time of grafted bone was 6.9 months, grafted bone resorption was noted in 18 hips.The degree of resorption was mild and moderate, but there was no clear affection on the coverage and stability of prosthesis. Acetabular revision was performed in 6 hips, of which 2 hips were due to esteolysis and four hips due to dislocation and wear of polyethylene liner. Condusion： After intermediate term of following-up of acetabuloplasty using structural bone graft in acetabular deficiency, we note the mild graft resorption in some cases, but the most cases showed satisfactory result and stable fixation.