生物学固定骨小梁金属杯在髋臼翻修中的应用

Cementless acetabular revision arthroplasty using porous tantalum cup

[目的]针对初次固定臼杯松动,其所需髋臼翻修选用何种材料和固定方式为佳,尚无定论。本研究肯定了设计新颖的组配式骨小梁金属杯的早期效果。[方法]自2006年4月-2006年11月期间本院对16例髋臼假体翻修病人使用了骨小梁金属杯,共计16髋,女9人,男7人,平均69.2岁。每个病人术前及术后6个月、1、2年进行Harris髋关节（HHS）评分、UCLA（university of california Los angeles）评分及骨盆前后位片的拍摄。所有病人随访的临床及影像学资料完整。[结果]术后随访18～25个（平均24个月）,Harris评分由翻修前的21～54分（平均32.6分）增加到术后的56～90分（平均87.5分）,UCLA评分由翻修前的2～5分（平均3.8分）增加到术后的6～9分（平均8.2分）,无假体移位及下沉等不稳迹象,骨小梁金属杯周围骨质内向长入。[结论]初次用骨水泥固定人工髋臼杯失败的病例,若无骨缺损,翻修时使用骨小梁金属杯可以获得良好的早期效果。

[ Objective] The best treatment method for cemented acctabular component loosening during revision hip replacement has not been established. The purpose of this study is to determine the initial results obtained with a unique implant the modular porous tantalum cup, designed as an ahernative treatment for aseptic prosthesis loosening following total hip arthroplasty. [ Method] From Apr. 2006 to Nov. 2006,porous tantalum cups were implanted during sixteen revision total hip replacements in nine women and seven men who had an average age of 69.2 years at the time of the procedure. Harris score and UCLA activity score were measured before, at 1,2 years and after arthroplasty. Radiographic follow-up was performed simultaneously. All patients were followed-up clinically and radiographleally. [ Result] The mean follow-up period was 24 month （range18 -25months ）. The mean preoperative Harris hip score（HHS） was 21 - 54 （32.6） compared with the postoperative HHS of 56 - 90 （87.5）. The mean preoperative UCLA score was 2 -5 （3.8） compared with the postoperative score of 6 -9 （8.2）. Radiographic evaluation of the revised components demonstrated no evidence of loosening or subsidence,and all showed radiographic evidence of bone ingrowth. [ Conclusion ] At the time of short-term follow-up, the porous tantalum cup effectively provided structural stability for acetabular component failure of cemented primary fixation. The potential for long-term biologic fixation may provide durability for porous tantalum cup. Long-term follow-up and comparison with alternative revision techniques will be required to evaluate the true effectiveness of this treatment approach.