髋关节置换翻修术骨质缺损的处理

Treatment of Bone Defect in Hip Revision

探讨全髋关节置换术后翻修术骨质缺损处理方式的选择。对29例病人(29髋)行髋关节置换术后翻修术;其中骨水泥型假体置换3例,非骨水泥型假体置换26例;3例为Synergy+Reflection假体,余为CLS+ALLOFIT假体。患者伤口均一期愈合,无术后早期感染征象。随访25例25髋,平均随访时间58个月。关节局部疼痛缓解,活动功能满意;术后随访X线片示:骨质愈合好,未见明显的骨质吸收征象。Harris评分,术前平均36.8分,术后平均93.2分。翻修距初次全髋关节置换平均13.7年。髋臼部骨质缺损,在髋臼覆盖大于80%的情况下可不植骨;若髋臼覆盖大于50%、小于80%,行颗粒性植骨结合结构植骨;髋臼覆盖的比例低于50%,结构植骨往往能获得较好的效果。股骨侧骨质缺损,打压颗粒植骨结合异体皮质骨板效果满意。

To investigate the option of treatments for bone defect in femoral revision after total hip replacement （THR）, 29 patients （29 hips） who had undergone hip replacement 13. 7 years previously were hospitalized again to undergo revisions. 3 patients were given cement protheses and the other 24 patients were given non-cement protheses. In 3 cases were used Synergy＋Reflection protheses, and in the others were used CLS ＋ALLOFIT. All of the patients have got primary healing without early infection symptoms post-operatively. We have been following up 25 cases（25 hips） for 58 months averagely. All the hip joints functioned well. Harris score increased from preoperative 36.8 to postoperative 93.2. In our experience, if there exist significant bone defect in acetabular bone and the coverage of the cup by the graft is more than 80%,bone graft is not needful. If the coverage is between 50% and 80% ,bone grains combining bone segment grafts are needful. If the coverage is less than 50%, bone segment grafts be likely to give good effect. In summary, compacted bone grains grafts combining allograft osintegumentale plate could gain satisfactory outcome for femoral bone defect.