人工全髋关节置换术中自体骨重建髋臼骨缺损的临床研究

The application of structural autograft for acetabular defect in total hip arthoplasty

目的探讨人工全髋关节置换术中用自体结构性植骨重建髋臼骨缺损的疗效。方法患者共26例29髋,自体股骨头植骨23髋、自体髂骨取骨6髋。骨缺损以打磨的髋臼假体骨床半球面积计算,骨缺损最大者有1602mm2,最小390mm2,平均每例缺损874mm2。全部采用非骨水泥型髋臼假体、2～3枚螺钉固定髋臼假体。临床评价采用Harris评分,X线观察移植骨愈合、骨和假体间骨长入和髋臼假体的稳定情况等。结果随访6个月～8年6个月,平均随访时间为(4.2±1.7)年,本组Harris评分平均从(52.2±16.7)分提高到(86.7±6.2)分(P<0.05)。所有病例髋臼假体稳定、周围无放射透亮影,假体髋臼骨面均有骨长入,移植骨愈合。X线片显示移植骨愈合时间3～6个月,平均为5.1个月。本组尚无术后翻修病例。结论采用自体骨进行结构性植骨或混合少量异体骨重建髋臼顶、前和后侧壁缺损(AAOS)髋臼缺损中Ⅱ、Ⅲ型缺损),经过近中期随访,移植骨全部愈合良好,获得满意的疗效。

Objective To evaluate the effectiveness of structural autograft for acetabular defect in total hip arthoplasty. Methods 29 hips of 26 patients were included. Autogenous femoral head was used in 23 hips, and autogenous iliac bone graft was used in six hips. The acetabular defect area was calculated with the reference of the bony mattress area for acetabular component, which was 874 mm2 in average （ 390 mm2 - 1 602 mm2 ）. Non-cemented acetabular component with two to three screws fixation were used in all the cases. Harris hip scores, bone grafts healing, bone ingrowth, and stability of the component under radiography were evaluated. Results The follow-up period was six months to eight years and six months, （4. 2 ± 1.7） years in average. Harris hip scores improved from （52. 2± 16. 7） to （86.7 ±6. 2） （ P 〈 0. 05 ）. All cases showed stable acetabular component, ingrowth of the bone to acetabular component, healing of the grafts and no radiolucency around components. Healing of the grafts needed three to six months, 5.1 months in average. No revision surgery was needed postoperatively. Conclusions Using structural autografts or combined with little allografts to reconstruct the top, anterior and posterior defect of the acetabular （ AAOS Classification of type Ⅱ、Ⅲ Acetabular Deficiencies） , short and mid-term follow-up showed healing grafts of all cases and satisfactory clinical results.