远端固定生物假体结合异体颗粒骨植骨在股骨假体翻修术中的应用

Application of uncemented distal fixation femoral prosthesis combined with allograft in femoral revision with proximal bone defect

目的探讨远端固定生物型股骨假体结合异体颗粒骨植骨在近端骨缺损型股骨翻修术中的应用。方法 2001年4月至2008年10月对23例非感染性股骨假体松动患者进行翻修手术,其中2例为再次翻修,均采用远端固定生物型股骨假体结合异体颗粒骨植骨。男9例,女14例,年龄57～77岁,平均64岁。翻修前人工股骨头置换7例,全髋关节置换16例,从初次关节置换到翻修手术的间隔时间最短6年,最长16年,平均12.6年。股骨骨缺损根据Paprosky分型,Ⅰ型8髋,Ⅱ型11髋,ⅢA型4髋。术前Harris评分(39.3±14.6)分。翻修用假体:MP(Link)2髋,AML(DePuy)13髋,Full-coated(Zimmer)6髋,Enchelon(Smith-Nephew)股骨距替代型假体2髋。结果本组术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,平均随访时间38个月(22～56个月)。术后Harris评分为(87.6±9.4)分,与术前比较差异有统计学意义(P<0.05)。术后X线摄片显示植入骨愈合良好,假体部位骨皮质密度和厚度明显增加。结论远端固定生物型股骨假体结合异体颗粒骨植骨应用于伴有近端骨缺损的股骨翻修术中,中短期疗效满意,远期疗效尚待进一步随访。

Objective To evaluate the clinical outcomes of the application of uneemented distal fixation femoral prosthesis combined with a11ograft in the femoral revision with proximal bone defect. Methods From April 2001 to October 2008,23 aseptic loosening femoral stem were revised, and 2 of them were rerevision surgery. 9 males, 14 females, the average age of patients was 64 （57-77）. The interval between the primary athroplasty and the revision was from 6 years to 16 years. Based on the Paprosky classification system,type Ⅰ was 8 cases;type Ⅱ was 11 cases ; type ⅢA was 4 cases. The Harris hip scores were （ 39. 3±14. 6） points preoperatively. Femoral stems for revision include 2 cases of MP stem（ Link）, 13 cases of AML stem（DePuy） ,6 cases of Full-coated stem（Zimmer） and 2 cases of Enchelon calcar replacement stem（Smith-Nephew）. Results The incision healed by first intention in all patients. No patient suffered complication after operation. The Harris score were （87. 6±9. 4 ） points postoperatively, showing statistically differences （P 〈 0. 05 ）when compared with preoperation. The radiographs obtained after the revision showed that bone graft healed well. Conclusions The application of uncemented distal fixation femoral prosthesis combined with allograft can get good clinical result in the femoral revision with proximal bone defect.