全髋关节翻修术中髋臼骨缺损的重建

The treatment of the acetabular deficiencies in the revision of total hip arthroplasties

目的探讨全髋关节置换术(THA)后,翻修术中髋臼骨缺损重建的方法及疗效。方法对81例(84髋)在THA翻修术中处理的髋臼骨缺损患者进行回顾性分析,根据AAOS分型法,Ⅰ型7髋,Ⅱ型56髋,Ⅲ型17髋,Ⅳ型4髋。分别采用大直径非骨水泥假体臼、非骨水泥假体臼+松质颗粒植骨、骨水泥假体臼+Cage+松质颗粒植骨和骨水泥假体臼+定制型假体+松质颗粒植骨等方法,对不同类型骨缺损的患者进行修复。术后定期随访,采用Harris方法评估髋关节功能,根据X线片判断假体是否有松动,移植骨是否愈合。结果对本组患者进行术后随访,平均随访45个月(13～118个月)。术后Harris评分平均86.2分,较术前平均改善40.6分。2髋因脱位需进行再翻修,其余效果良好,X线片无假体松动下沉,可见移植骨-宿主骨交界处有连续性小梁骨通过。结论在THA翻修术中,大部分髋臼骨缺损可使用较大型号非骨水泥假体或加松质颗粒植骨进行修复;对于影响假体稳定性的较大缺损,使用骨水泥假体臼+Cage+松质颗粒植骨的方法可获得良好效果;定制型假体在处理严重髋臼骨缺损中有独特优势,具有良好的临床应用前景。

Objective To evaluate the treatment and effect of the aeetahular deficiencies in revision total hip arthroplasties. Methods 84 revision total hip arthroplasties （81eases） in conjunction with acetabular deficiencies were followed up. According to AAOS system, type Ⅰ （segment deficiencies） in 7 hips, type Ⅱ （cavitary deficiencies） in 56 hips, type Ⅲ （combined deficiencies） in 17 hips and type Ⅳ （Pelvic discontinuity） in 4 hips. We used acetabular enlarging and rasping, morselized cancellous hone grafting, Cage or hemipelvic prosthesis respectively or combinedly, depending on defect types. The noncemented or cemented fixed methods were used. The Harris Hip score was used to evaluate the hip functions. The X-ray was used to evaluate the loosening of prosthesis and the union of the bone graft. Results The mean follow-up was 45 months （13 -118 months）. The mean Harris Hip Score was 86.2 points, 40. 6 pionts higher than preoperative. In X-ray, there was no prosthetic loosening and showed evidence of trabecular bridging between the graft and host bone. One hip accepted re-revision for dislocation, two hips showed the discontinuously radiolucent lines around the acetabular component. Conclusions In the revision of THA, the majority acetabular deficiencies could be treated by large diameter prosthesis or plus with morselized cancellous bone graft. For the large deficiencies that influence the prosthesis stability, the choice of morselized cancellous bone draft, plus Cage and cemented prosthesis may acquire good effect. The custom-made prostheses have distinctive advantages to serious bone defect, and have a desirable clinical prospect.