钽金属臼杯重建髋臼骨缺损的近期疗效

Reconstruction of acetabular bone loss with porous tantalum acetabular components in total hiparthroplasty

目的探讨应用钽金属臼杯对不同类型髋臼骨缺损进行重建的近期疗效。方法回顾性分析2009年8月至2012年4月在全髋关节置换术中使用钽金属臼杯重建髋臼骨缺损的连续21例患者的病例资料，男6例，女15例；年龄24～78岁，平均（53．7±16．2）岁。初次全髋关节置换5例：Crowe1V型髋关节发育不良2例、髋关节感染后遗高位脱位畸形2例、类风湿关节炎1例；全髋关节翻修16例：全髋关节置换术后感染二期翻修2例、髋臼金属炎性假瘤3例、假体无菌性松动11例。骨缺损Paprosky分型I型9例，Ⅱa型4例，1Ib型5例，IIc型1例，Ⅲa型1例，Ⅲb型l例。观察术后髋臼假体周围透光线、假体位置、生存率、并发症及Harris髋关节评分。结果全部病例随访6-40个月，平均20．1个月。末次随访时PaproskyI型患者的Harris髋关节评分（87．2~7．4）分，高于术前（41．1~6．3）分；Ⅱ型（79．8±11．8）分，高于术前（38．4±12．5）分；BI型为79分，高于术前24分。随访期间钽金属臼杯固定良好，未出现松动及移位，假体生存率100％。按照Anderson骨长入影像学评价标准，髋臼杯均出现不同程度骨长入。1例于DeLee—Charnley髋臼3区出现透光线，4个月后消失；1例于髋臼1区出现假体周围间隙，随访6个月未进展。l例于术后4周出现后脱位。结论应用钽金属臼杯重建PaproskyI、Ⅱ型髋臼骨缺损，能实现早期与宿主骨整合，近期疗效好。

Objective To explore the early-term efficacy of the reconstruction of acetabular bone loss with porous tantalum acetabular components in total hip arthroplasty. Methods Twenty-one patients （21 hips） were included in this study, which had an acetabular replacement with tantalum acetabular compo- nents from August 2009 to April 2012. There were 6 males and 15 females, with the mean age of 53.7±16.2 years （range from 24 years to 78 years）. The primary total hip arthroplasty in 5 cases, the revision in 16 cas- es. The acetabular bone defects were classified as Paprosky classification, which included, type I in 9 cas- es, type Ⅱ a in 4, type IIb in 5, type Ⅱ c in 1, type Ill a in 1 and type Ⅲ b in 1 case. Results The mean follow-up time was 20.1 months （range, 6-40 months）. In Paprosky I , the Harris hip score was 87.2±7.4 postoperatively, which was significant higher than the preoperative score 41.1±6.3. In Paprosky Ⅱ, the Har- ris hip postoperative score （79.8±11.8） was significant higher than the preoperative score （38.4±12.5）. In Pa- prosky Ⅲ, the Harris hip postoperative score （79） was significant higher than the preoperative score （24）. 21 Tantalum components were well fixed by the radiograph imaging. No cases suffered aseptic loosening and migration. Bone ingrowths was obviously performed in 21 hips. But 2 hips had a radiolucent line, 1 case oc- curred in zone 3 and the line was filled 4 months later, the other case still existed at last follow-up without any more widen. No infections or mechanical failures. The survivorship of the tantalum acetabular compo- nents was 100%. Conclusion Our short-term results suggest this implants may enhance biological fixation in acetabalar defect cases. Porous tantalum cup appears to be an ideal material to facilitate biologic in- growths in these cases. Long-term follow-up still needs to be confirmed.