全髋关节髋臼骨溶解的特点和治疗对策

Features and treatments of the pelvis osteolysis in total hip arthroplasty

目的分析全髋关节置换术后髋臼骨溶解发生的特点,观察不同治疗方法的近期临床结果。方法对8例髋臼松动患者通过术前X线的评估,比较骨水泥臼和非骨水泥臼骨溶解的不同特点。并对由骨溶解造成的髋臼骨缺损进行Paprosky分型,其中4例进行了颗粒打压植骨和加强杯(roof reinforcement ring)骨水泥臼翻修,1例在原来的金属臼内植入骨水泥臼,另外3例进行了颗粒打压植骨非骨水泥臼固定。对手术后的患者进行放射学和髋关节功能的随访。结果骨水泥臼和非骨水泥臼在骨溶解的发生上有不同的特点。髋臼骨缺损根据Paprosky分型,Ⅰ型2例,Ⅱ型4例,Ⅲ型2例。随访12个月无感染和脱位等并发症。X线发现髋臼固定牢靠。8例患者术前平均Harris评分36分,术后1年89分。结论骨水泥臼和非骨水泥臼骨溶解有不同特点,术前充分的X线评估和术中有效的植骨固定是手术成功的关键。

Objective This study was conducted to analyze the specific features of the pelvis osteolysis in total hip arthroplasty and the short-term results of different treatments. Methods Eight hips of acetabulum loosening were revised in 2005. The different features of the osteolysis were compared radiographically. Four hips were revised with impacted bone graft and fixed with roof reinforced rings and cemented cups. One was revised with the fixation of a cemented cup within the original metal shell. Other 3 hips were revised with impacted bone graft and implantation of noncement cups. The patients were followed up for l year radiographically and functionally. Results According to Paprosky classiticatien, the deficiencies of the acetabulurn were classified as type Ⅰ in 2 hips,type Ⅱ in 4 hips,and type Ⅲ in 2 hips, There were no infection and dislocation after 12-month follow up. The cups were fixed well and there were no interfaces between the grafted bone and the trabecular bone of the acetabulae. The average Harris hip score of the 8 hips was 36 before operation and 89 after operation. Conclusion The osteolysis of the acetabulum has different features in cemented and cementless hip replacement. The precise preoperative radiographical evaluation and the effective bone graft are the key of successful treatment.