假体置入及骨移植与髋臼翻修:理论与应用

Prosthesis implantation, bone transplantation, and acetabular revision: Theory and application

背景:伴有骨缺损髋臼翻修的影响因素主要为以下三方面,即翻修前对髋臼缺损的准确评价,髋臼骨结构的重建,髋臼翻修假体的合理选用。目的:从影响髋臼翻修效果的三个关键方面加以分析、综述,以期为临床根据患者的具体情况制定合理翻修方案提供帮助和参考。方法:由第一作者进行检索,检索文献时限为1990-01/2009-06。检索数据库为PubMed数据库,中文关键词为"髋臼,翻修,骨缺损";英文关键词为"acetabularrevision,boneloss",限定语言种类为英语。总结并归纳了近20年来发表于国内外核心期刊上的关于髋臼翻修的临床研究文献,对于初次关节置换及股骨假体翻修病例、有关动物实验的文献则不予参考。结果与结论:共检索到61篇文献,对资料进行分析,根据上述筛选标准,并以近5年文献为主,排除31篇内容与课题目的不符的文献,纳入30篇。通过对文献的复习可知,重建髋臼骨性结构,恢复髋关节原始旋转中心,是影响修复效果的前提和关键因素,在此基础上选用合适的髋臼翻修假体,可取得良好的修复效果。目前,通过骨移植修复骨缺损,加上非骨水泥假体对伴有骨缺损的髋臼进行翻修的方法是一个较好的选择。

BACKGROUND： The main factors that influence revision of acetabular bone defects include evaluation of acetabular bone defects, reconstruction of acetabulum and appropriate acetabular cups used in revision. OBJECTIVE： The review from the three aspects will help to choose an appropriate cup in revision and to formulate the best revision protocols. METHODS： A computer-based online search of PubMed was performed for English articles published from January 1900 to June 2009 with the key words of acetabulum, revision, bone defect, in English and Chinese. Clinical studies published in core periodicals of the latest twenty years were reviewed. Articles regarding primary joint replacement, femoral prosthesis revision and animal experiments were excluded. RESULTS AND CONCLUSION： A total of 61 articles were analyzed, 31 were excluded, and 30 mainly published in 5 years, were included. Reconstruction of acetabular bone structure, restoration of original rotation center of hip joint are key factors for repair. Moreover, appropriate prosthesis further benefits the repair effect. Bone transplantation for bone defect and cementedless prosthesis have become favorable methods for revision of acetabular bone defects.