人工髋关节再置换术中骨移植的应用

Application of bone graft in revision total hip arthroplasty

目的比较自体骨移植、同种异体骨移植以及混合骨移植的愈后及差别。方法４１例病人移植骨使用自体髂骨和本单位贮存低温冷冻股骨头。自体骨移植１８例，同种异体骨移植８例，混合骨移植１５例。分别在６周、３、６、１２个月及１２个月以上观察Ｘ线片。结果６周时，移植骨为吸收像，约３１％（１３／４１）；３个月时，出现愈合征象约８８％（３６／４１）；６个月时，移植骨重塑开始约３９％（１６／４１）；１２个月时，除４例假体松动的病人外，其余３７例全部出现重塑。４例假体松动的病人中，３例细菌性感染，１例移植骨坏死吸收。另外５例并发症为：术后人工股骨头脱臼１例，股骨干骨折３例，股骨大粗隆不愈合１例。结论移植骨愈合过程中，自体骨与同种异体骨之间。

Objective To compare the differences of bony union in autograft, allograft and their mixturegraft. Methods The postoperative Xray films of revision total hip arthroplasties with acetabular bonegraft were observed in 41 patients. They were women, aged at operation from 44 to 86 years (average 65 years). Followup ranged from 12 to 72 months (average 29 months). At the operation, autogenous bone was taken from the iliaccrest and homologous bone was from banked bone i.e. femeral head taken previously. Of these, 18 were autografts, 8 allografts, and 15 mixturegrafts. Bone incorporation was observed postoperatively on 6week, 3month, 6month, 12month and over 12month films. Results At 6 weeks, graft absorption appeared in 31% patients (13/41)At 3 months, bridging trabeculation across the grafthost interface was present in 88% patients, (36/41). At 6 months, graft remodeling began in 39% patients (16/41). At 12 months, graft remodeling was considered in 37 patients, and radiolucent prothesis in 4 (infection in 3 patients and graft absorption). Conclusion No difference is observed in the time and the condition of bone union between autograft and allograft, autograft or allograft and their mixture graft.