髋臼加强杯在髋臼翻修术中的应用

Acetabular revision arthroplasty using antiprotrusio cage

目的 观察髋臼加强杯在髋臼翻修手术中巨大髋臼骨缺损修复中的应用疗效.方法 2003年2月至2008年10月对12例在翻修术中存在严重髋臼骨缺损的患者采用植骨与髋臼加强杯重建髋臼骨缺损后固定假体.手术前、后情况进行临床评估及影像学评估.术前骨缺损分类按Paprosky分型：ⅡB型2例,ⅢA型6例,ⅢB型4例.术前Harris评分平均为35.2分.结果 术后所有患者均获随访,平均随访时间37个月（9～71个月）;术后第一次随访时Harris评分平均为80.9分,末次随访时平均84.6分.术后假体无松动或断裂.有1例患者翻修术后6个月于髋臼Delee＆Chamley Ⅲ区出现轻度放射线透亮带,但继续随访未进展.未出现假体失败而需要再次翻修病例.结论 采用髋臼加强杯联合植骨技术可有效修复髋臼骨缺损,重建髋臼结构稳定性,中短期随访疗效可靠.

Objective To study the efficacy of acetabular antiprotrusio cage for the reconstruction of acetabular bone defect in revision hip arthroplasty. Methods Twelve cases of severe acetabular bone defect after total hip arthroplasty were revised with antiprotrusio cage and bone grafting from February 2003 to October 2008. Clinical and radiological data before and after revision surgery were collected and compared for assessment Results The classification of acetabular bone defect of this group of patients according to Paprosky classification was; 2 cases of type Ⅱ B, 6 cases of type Ⅲ A and 4 cases of type Ⅲ B. The average postoperative follow-up period was 37 months （9-71 months）. Mean Harris score of all cases was 35. 2 before revision surgery, 80.9 at the first time follow-up and 84.6 at latest follow-up. There were no prosthesis loosening and breakage. There was mild radiolucent line in Delee ＆ Charnley Ⅲ zone of the acetabulum in one patient 6 month after revision, but no deterioration was found during further follow-up. No further revision was needed in this group of patients during the follow-up. Conclusions Reconstruction of acetabular bone defect using antiprotrusio cage and bone grafting is a useful method to restore the bone defect and stability of the acetabulum. The outcome via short to middle term follow-up is encouraging.