辐照深冻异体骨打压植骨在髋臼翻修中的应用

Acetabular revision with impacted irradiated frozen allografts

目的 研究辐照深冻异体骨用于髋臼翻修中严重骨缺损的打压植骨重建的临床效果.方法 2006年2月至2009年1月髋关节翻修术中共有20例21髋应用打压植骨技术结合金属网重建严重髋臼侧骨缺损,18例19髋获得随访.患者翻修时平均年龄为64.4岁（43～81岁）.采用Paprosky分型,本组患者均有髋臼骨缺损,其中PaproskyⅡB型4髋,PaproskyⅡC型8髋,PaproskyⅢA型5髋,PaproskyⅢB型2髋.手术用金属网修复髋臼节段性缺损,采用辐照深冻同种异体颗粒骨打压植骨结合骨水泥臼杯完成髋臼翻修.患者术后定期进行影像学和临床评估,观察手术前后髋关节Harris评分变化,假体移位松动及异体骨骨整合情况,及术中、术后并发症等.术前Harris评分平均42.5分（31～56分）.术前疼痛评分平均14.4分（10～20分）.结果 患者平均随访时间22.4个月（12～48个月）.术后Harris评分提高到88.6分（82～96分）.术后疼痛评分提高至平均42.3分（40～44分）.并发症：术后感染1例,经清创愈合.股神经损伤1例,术后1年随访时已恢复正常.1例患者术后出现股骨近端外侧皮质吸收,大粗隆骨折.有1例Paprosky ⅢB型患者出现金属网及髋臼杯明显移位等影像学松动表现,其余18髋的髋臼假体稳定,未发现臼杯在垂直和水平方向大于1 mm的移位,也未发现髋臼假体外展角的改变;植骨层和宿主骨床可见连续骨小梁通过、移植骨与周围骨床骨密度趋向一致等骨整合表现.结论 金属网与打压植骨及骨水泥髋臼技术联合应用能有效地完成髋臼的生物学翻修.辐照深冻异体骨用于打压植骨能与周围骨床很好的整合.

Objective To analyze the clinical and radiographical result of acetabular revisions with wire mesh, impacted irradiated frozen allografts and cemented cups. Methods From February 2006 to January 2009, a total of 20 patients with 21 acetabular revisions were performed with wire mesh, impacted irradiated frozen allografts and cemented cups. Eighteen cases （19 hips） were followed up. There were 5 hips in 4 males and 14 hips in 14 females. The average age of patients was 64.4 years （43 to 81 years）. Acetabular bone defects were classified according to Paprosky classification. There were Paprosky Ⅱ B in 4 hips, Paprosky Ⅱ C in 8 hips, Paprosky Ⅲ A in 5 hips and Paprosky HI B in 2 hips. Wire mesh was used to converted segmental defects into cavity defects. Irradiated frozen allografts were impacted and cemented cup was inserted to complete the revision. Patients were followed up regularly with clinical and radiographical assessment Harris score, migration and loosening of prosthesis grafts integration and complications were observed. Results The average follow-up time was 22. 4months （12-48 months）. Harris score improved from 42. 5 points（31-56 points） pre-operation to 88.6 points （82-96 points） at the final follow up. Pain score was 14.4 point（10-20 point） before revision and 42.3 points（40-44 point） at the final follow up. Complications： there was 1 infection and healing after debridement. One patient had weakness of quadriceps and returned to normal after 1 year. Greater trochanter fracture occurred in 1 patient Cup migration and loosening were observed in 1 Paprosky Ⅲ B patients. There was no cup migration more than 1 mm or change of abduction angle in the remaining 18 hips. Grafts incorporation defined as the presence of trabecular bone crossing the graft-host bond could also be seen in these 18 hips. Conclusions Impacted bone grafting technique combined with wire mesh and cemented cup is an effective method for biological acetabular revision. Irradiated frozen allografts implanted with impaction bone grafting technique can integrate with the surrounding host bone.