异体骨移植修复髋关节翻修术中骨缺损的中期随访

Treatment of bony defects in revision total hip arthroplasty with allograft grafting:midterm follow-up study

[目的]探讨在髋关节翻修中采用异体骨修复骨缺损的中期疗效。[方法]对2000～2005年间采用异体骨修复髋关节翻修术中骨缺损而获得随访的22例22髋进行回顾性分析,其中男13例,女9例;年龄45～80岁,平均65.5岁。根据AAOS分型:髋臼缺损Ⅰ型5髋,Ⅱ型14髋,Ⅲ型3髋;股骨缺损Ⅰ型3髋,Ⅱ型12髋,Ⅲ型2髋,5髋无明显缺损。骨缺损重建方法:髋臼侧结构性植骨5髋;颗粒骨植骨12髋;钛网联合颗粒骨植骨5髋。股骨侧结构性植骨3髋;颗粒骨植骨12髋;钛网联合颗粒骨植骨2髋;5髋没有植骨。根据Harris评分和X线对其临床效果进行评估。[结果]术后平均随访61个月,Harris评分由翻修前平均45分增加至术后86分。1例出现伤口渗液;1例仍轻度疼痛。未见假体移位及透亮带,没有再翻修病例。[结论]全髋翻修中,根据骨缺损类型,选用相应异体骨修复骨缺损,中期随访效果满意。

[ Objective] To explore the intermediate result of the use of allograft grafting for bone defects in revision total hip arthroplasty. [ Methods] A retrospective study was carried out on 22 patients （22 hips） with the use of allograft grafting for bone defects in revision of total hip arthroplasty from April 2000 to April 2005. There were 13 male and 9 female with mean age of 65.5 years. According to the AAOS system, the bone defects in acetabulum were classified into type Ⅰ in 5 hips, type Ⅱ 14 hips and type Ⅲ 3 hips, and on the femoral side , they were classified into type Ⅰ in 3 hips, type Ⅱ 12 hips and type Ⅲ 2 hips. The reconstruction of bone defects in acetabulum contained structural bone graft in 5 hips, impaction bone graft in 12 hips, and metal wire mesh with bone graft in 5 hips. On the femoral side, 3 hips were dealed with structural bone graft, 12 hips were done with impaction bone graft, and 2 hips were repaired by metal wire mesh with bone graft. Harris Hip Score System and radiography were used to evaluate the clinical efficiency. [ Results ] The mean follow - up time was 61 months （ 37 - 97 months） . Harris score improved from 45 points （30 -65） pre -revision to 86 points （62- 96） at the final follow -up. Insion drainage occurred in one hip. One patient remain slight pain in hip. No prothesis loosening, radiolucent lines were observed during the follow -up. None need to second revision. [ Conclusion ] During the THA revision surgery, adopting suitable allografts to repair the different types of bone defects is feasible and the mid - term result is good