打压植骨结合金属网重建髋臼严重骨缺损

Reconstruction of the severe acetabular bone defect by using metal mesh and impaction bone grafting technique

目的评价打压植骨结合金属网重建严重骨缺损髋臼的中期临床效果，分析Paprosky骨缺损分型在评价骨缺损时的重要性。方法1998年12月至2007年12月采用打压植骨技术结合使用金属网片和（或）金属网杯进行严重髋臼缺损重建63例（67髋），所有患者均为AAOS Ⅲ型混合型缺损。其中58例患者（61髋）获得了完整随访，平均63个月。Paprosky Ⅱ B19例（20髋），PaproskyⅡC27例（28髋），PaproskyⅢA12例（13髋）。术前Harris髋关节评分平均41．7分（21～52分）。术后随访时进行临床疗效、影像学及并发症等评估。结果58例（61髋）患者Harris髋关节评分术后平均89．2分（81—98分），术后优良率达93％，除3例发生聚乙烯髋臼从网杯中脱出外，其余55例患者髋臼无影像学松动。1例使用金属网杯患者髋臼旋转中心未能恢复正常。3例术后脱位患者，其中2例手法复位，1例切开复位，均获成功。术后发生感染1例（1．6％），经二期翻修打压植骨成功治愈。结论异体骨打压植骨配合金属网是处理严重髋臼骨缺损的理想技术。建议在使用打压植骨技术对严重髋臼缺损重建时，采用AAOS分型结合Paprosky分型方法对缺损的严重程度进行评价。金属网杯不适用于严重髋臼骨缺损的打压植骨再建。

Objectives To evaluate the medium-term clinical results of reconstruction of the severe acetabular bone defect by using metal mesh and impactiou bone grafting （IBG） technique, as well as to emphasize the importance of Paprosky acetabular bone defect classification system in assessing the severity of bone defect and to analyse the failure reasons. Methods Between December 1998 and December 2007, 67 total hip arthroplasty（THA）revisions were made by using IBG technique to reconstruct severe acetabular bone defects combining with metal mesh or meta mesh cup on 63 patients. All the defects were combined defect（ AAOS Type 3 ）. There were 20 Paprosky Ⅱ B defects in 19 patients, 28 Paprosky Ⅱ C defects in 29 patients and 13 Paprosky Ⅲ A defects in 12 patients. Regular follow-ups, involving the assessments of Harris hip scoring system, clinical efficacy, imaging and complications, were subsequently made. Results Sixty-one hips in 58 patients gained an average of 63 months （ 8-107 ） follow-up. Harris hip score increased from an average of 41.7 points （21-52） preoperatively to an average of 89. 2 points （81-98 ） at the last follow-up, with an excellent and good rate of 93%. Radiographically, there were no loosening cases excluding the 3 dislocated polyethylene cups from the metal mesh cups. One case was failed to reconstruction the height of normal hip center, in which metal mesh cup was used for inforce the medial wall. Dislocations occurred in 3 hips, 1 of these patients required an open reduction and the other 2 dislocations only need close reduction. Postoperative infection rate was 1.6% （ 1 case） , two stage revision with another IBG procedure succeeded in this patient. Conclusions IBG combing with metal mesh for reconstrution of severe acetabular bone defect is an ideal technology. Paprosky acetabular bone defect classification system is very important in IBG procedure besides AAOS acetabular bone defect classification system to evaluate the severity of bone defect and to compare the outcomes between different authors. The use of metal mesh cup should be avoided to inforce acetabular medial wall in patients with severe acetabular bone defect.