髋臼溶骨关节内陷的人工全髋关节置换临床分析

Total hip replacement for acetabular osteolytic arthrokatadysis

目的评价髋臼内打压植骨在髋臼溶骨关节内陷的全髋关节置换术中的应用效果。方法回顾分析2002年～2007年采用自体骨移植重建髋臼内壁治疗髋臼溶骨关节内陷的人工全髋关节置换术17例23髋,其中男11例,6例为双髋;女6例,均为单髋。年龄24～46岁,平均35.6岁。术前Harris评分15～45分,平均32.3分。将切除股骨头或自体髂骨按缺损情况制成小块,对髋臼深部的溶骨内陷区进行打压植骨,恢复髋臼臼壁的厚度、包容性和臼底的耐压能力,然后进行髋臼安装。结果 17例23髋均获随访2～6年(平均4.7年)。术后肢体长度平均增加1.8cm。植骨愈合良好,随访中未见植骨区骨质吸收及假体松动。术后1年和最后随访时平均Harris评分分别为91.8和87.3分,与术前Harris评分比较有统计学意义(P<0.05)。术后1年和最后随访时优良率分别为90.8%和89.2%。结论采用自体骨重建因基础疾病所致的溶骨破坏吸收可增加髋臼的厚度、增强对臼杯的把持能力,对髋关节旋转中心的恢复和术后髋关节功能的稳定具有重要意义。

Objective To evaluate the effect of impaction bone grafting for acetabular osteolytic arthrokatadysis. Methods twenty-three acetabulums in 17 patients who were treated between 2002 and 2007 were involved. They were 11 males, 6 of whom had both acetabulums affected and 6 females who had single acetabulum affected. They were aged from 24 to 46, with the average of 35.6. Preoperative Harris score was 15 to 45, with the average of 32.3. We cut the resected femural bone or the autogenous iliac bone into small pieces based on the scale of the damage, and perform impaction bone grafting in the sunken area, then restore the thickness of the acetabulum wall, inclusiveness and compression resistance of the bottom, of the acetabulum. We finally performed installation. Results All patients were followed up for 2 to 6 years, with the average of 4.7 years. Postoperative limb lengths increased by 1.8cm on average. Bone graft healed well. No bone absorption or prosthesis loosening occurred in follow-up. The Harris score of 1 year after surgery and the last follow-up were 91.8 and 87.3. Compared with the preoperative ones, Harris score was statistically significant （P〈0.05）. The excellent rate of 1 year after surgery and the last follow-up were 90.8% and 89.2%. Conclusions As for osteolytic absorption due to basic diseases, autologous bone remodeling can increase the thickness of the acetabulum, and enhance the control of capacity. It has great significance to the restoration of the joint rotation center and the stabilization of the postoperative joint function.