加大号生物型臼杯在人工髋关节翻修术中的应用

EXTRA-LARGE UNCEMENTED ACETABULAR COMPONENTS FOR HIP REVISION

目的探讨在人工髋关节翻修术中应用加大号生物型臼杯（Jumbo杯）解决广泛髋臼骨缺损的早期疗效。方法2008年9月-2012年5月,对13例13髋合并广泛髋臼侧骨缺损的患者行人工髋关节翻修术,均使用Jumbo杯（男性直径≥64mm,女性直径≥60mm）。其中男4例,女9例;年龄58～84岁,平均64.7岁。均为单侧首次翻修;翻修距人工全髋关节置换术时间3～16年,平均9.6年;髋臼侧骨缺损根据Paprosky分型：ⅡA型2例,ⅡB型5例,ⅡC型4例,ⅢA型2例。术前测量股骨头假体中心至两侧泪滴连线的垂直距离较健侧增加（21.2±6.1）mm。手术前后行Harris评分及评估髋关节旋转中心变化情况。结果术后切口均Ⅰ期愈合,无关节脱位、感染及坐骨神经、股神经损伤发生。13例均获随访,随访时间13～40个月,平均23.5个月。患者术后髋关节疼痛均不同程度缓解或消失;除1例术后3个月因急性脑梗死致肢体偏瘫外,余患者均能正常下地行走,恢复大部分日常工作。X线片示随术后随访时间延长,植入的同种异体骨逐渐与宿主骨整合,无明显吸收;植骨融合时间9～35个月,平均14.5个月。末次随访时,股骨头中心点与双侧泪滴连线的垂直距离较健侧增加（6.0±3.1）mm,较术前明显下降（t=11.13,P=0.00）;假体周围无透亮区,假体无移位,螺钉无断裂;Harris评分为（85.1±3.2）分,较术前（30.4±8.8）分显著增加,差异有统计学意义（t=22.11,P=0.00）。结论使用Jumbo杯可有效解决伴广泛髋臼侧骨缺损的重建问题,早期疗效满意,假体长期生存率仍需进一步观察。

Objective To investigate the early-term effectiveness of extra-large uncemented acetabular components for hip revision in the treatment of extensive acetabular bone defect. Methods Between September 2008 and May 2012, 13 patients （13 hips） with extensive acetabular bone defect underwent first hip revision using extra-large uncemented acetabular components （Jumbo cup）. The diameter of Jumbo cup was larger than or equal to 64 mm for male and 60 mm for female. There were 4 males and 9 females with an average age of 64.7 years （range, 58-84 years）. The period from primary arthroplasty to revision was 3-16 years （mean, 9.6 years）. According to Paprosky classification, acetabular bone defect was rated as stage IIA in 2 cases, as stage IIB in 5 cases, as stage IIC in 4 cases, and as stage IIIA in 2 cases. The preoperative vertical distance from the center of involved femoral head to interteardrop line was （21.2 ＋ 6.1） mm longer than that of normal side. The Harris score and the rotation center of hip were evaluated preoperatively and postoperatively. Results Healing of incision by first intention was obtained in all patients, and no complication of dislocation, infection, and injury of sciatic nerve or femoral nerve occurred. The duration of follow-up ranged from 13 to 40 months （mean, 23.5 months）. Partial or complete pain relief was achieved in all patients. The other patients could walk independently and restored to their routine jobs except for 1 case of hemiplegia caused by acute cerebral infarction at 3 months after surgery. In 5 patients with bone implantation, with the prolonging follow-up, the allograft could integrate with the host bone without absorption, and the bone fusion time was 9-35 months （mean, 14.5 months）. At last follow-up, the X-ray films revealed that the vertical distance from the center of involved femoral head to interteardrop line was （6.0 _＋ 3.1） mm longer than that of normal side, which was significantly reduced when compared with preoperative value （t=-I 1.13, P=0.00）. No periprosthetic transparent region, prosthesis displacement, or screw breakage occurred. The Harris score was significantly increased from 30.4 ＋ 8.8 preoperatively to 85.1 ＋ 3.2 at last follow-up （t=-22.11, P=0.00）. Conclusion The application of extra-large nncemented acetabular components could be an effective technique for the reconstruction of extensive acetabular bone defect, and gain a good early-term effectiveness. The long-term survival rate of prostheses needs to be followed up.