单纯颗粒骨植骨治疗全髋翻修中的轻中度髋臼骨缺损

Simple particulate bone grafting for mild and moderate acetabular bone defect in total hip revision

背景：随着生物材料的改进及对髋臼翻修的进一步理解，目前对轻中度髋臼骨缺损的髋臼翻修倾向于使用生物型假体固定。目的：观察采用单纯颗粒植骨治疗轻中度髋臼骨缺损的临床效果。设计、时间及地点：回顾性病例分析，病例来自2003-06/2008—06同济大学附属东方医院骨科。对象：选择同济大学附属东方医院骨科收治的全髋翻修术中轻中度髋臼骨缺损患者10例，男5例，女5例；年龄43-77岁，平均58．8岁：前次手术距翻修手术3-10（70±0．5）年：初次手术应用骨水泥型全髋2例．非骨水泥型全髋3例，混合型全髋4例，双极股骨头半髋1例。髋臼骨缺损按AAOS分型：Ⅰ型6例，Ⅱ型4例。术前髋关节Harris评分平均40．6分。方法：采用单纯颗粒性植骨结合生物型假体治疗10例患者，采用髋关节后外侧入路，髋臼植骨后采用生物型髋臼杯固定并以螺钉固定，术后根据临床及X射线进行评估。主要观察指标：记录骨移植时间，移植过程中出血量，Harris评分及围手术期并发症。结果：所有患者均采用单纯颗粒性植骨结合生物型假体重建髋臼，1例术后1个月发生松动，二次手术改用特殊髋臼钢板结合颗粒骨移植，术后3个月弃拐行走。其余病例无并发症，平均随访3年，Harris评分平均87．0分。X射线除1例病例出现松动外，其余病例髋臼骨床与颗粒骨愈合，髋臼杯与颗粒骨块之间无完全性透亮带，无髋臼杯位移病例。未发现骨溶解现象，颗粒骨与宿主骨愈合良好。结论：单纯颗粒骨植骨治疗轻中度髋臼骨缺损简单、有效，早期随访效果好。

BACKGROUND： With the improvement of biomaterial and further recognition in aetabular revision, the main tendency is using biologic prosthesis for mild or moderate acetabular bone defect in total hip revision. OBJECTIVE： To observe the clinical effect of simple particulate bone grafting on mild or moderate acetabular bone defect in total hip revision. DESIGN, TIME AND SETTING： A retrospective case analysis. All cases were from Department of Orthopedics, Shanghai East Hospita/Affiliated to Tongji University from June 2003 to June 2008. PARTICIPANTS： A total of 10 patients with mild or moderate acetabular bone defect who received total hip revision were from Department of Orthopedics, Shanghai East Hospital Affiliated to Tongji University. Among them, there were 5 male and 5 female, with an average of 58.8 years old from 43 to 77 years old. Their last replace time were 3-10 years, with an average of （7.0±0.5） years. Two of them in the last replacement used cement components, three used cementless, four used mixture, and one used dipolar artificial thigh bone. According to AAOS typing, there were 6 cases of type Ⅰ and 4 cases of type Ⅱ. The average preoperative Harris hip joint score was 40.6. METHODS： Simple particulate bone grafting combined with biologic prosthesis was used to treat the 10 patients with mild or moderate acetabular defects. All operations were at the posterolateral approach. The acetabular cup and screw fixation were performed after grafting. The postoperative effect should be evaluated by clinical and X-ray manifestations. MAIN OBJECTIVE INDEX： The bone grafting time, bleeding volume, Harris score and complications in the perioperative period were recorded. RESULTS： All patients were adopted simple particulate bone grafting combined with biologic prosthesis to reconstruct the acetabular bone defects. One acetalum cup was found loose after one month. The titanium plate combined with particulate bone grafting was used in the second revision. At 3 months after operation, the patient could walk without crutch. No complication was found in other patients. An average of 3 years following-up was obtained. The average Harris score was 87.0. Except one acetalum cup was found loose, the X-ray showed that the bed of acetabulum and particulate bone was good healing and there was no complete transparent zone. There was no patient with displacement of acetalum cup. No osteolysis in any patient. The particulate bone and host bone had a good healing. CONCLUSION： The simple particulate bone grafting is simple and effective for mild or moderate acetabular bone defects with the good follow-up result in early period.