采用超大生物型臼杯行髋关节翻修术的疗效观察

EFFECTIVENESS OF ACETABULAR REVISION USING JUMBO CEMENTLESS CUPS

目的探讨采用超大生物型臼杯行髋关节翻修术的临床疗效。方法回顾分析1996年5月-2011年5月，采用超大生物型臼杯行髋关节翻修术的35例（35髋）患者临床资料。男12例，女23例；年龄47～79岁，平均64．8岁。初次关节置换至翻修术时间为1～15年，中位时间9．7年。翻修原因：假体无菌性松动32例，股骨假体周围VancouverB3型骨折2例，低毒性感染1例。髋臼侧骨缺损根据美国骨科医师协会（AAOS）分型标准：Ⅰ型6例，Ⅱ型9例，Ⅲ型20例；根据Paprosky分型标准：ⅡA型5例，ⅡB型9例，ⅡC型13例，ⅢA型8例。初次置换臼杯外径为46～52mm，平均49．6mm。翻修臼杯外径为56～68mm，平均60．4mm。采用Harris评分评价髋关节功能，并摄x线片行影像学评价。结果术后患者切口均I期愈合，无感染及神经、血管损伤等并发症发生。1例患者于术后20d发生假体脱位，对症处理后未再次脱位。35例患者均获随访，1例于术后6年死亡，其余34例患者随访时间2～14年，平均8．4年。髋关节Harris评分从术前的（46．4±13．4）分提高至末次随访时的（90．4±3．6）分，比较差异有统计学意义（t=-18．76，P=0．00）。X线片复查示，术后即刻髋关节旋转中心距泪滴间线距离、距泪滴外侧距离均较术前显著改善（P〈0．05）。除1例于术后10年出现髋臼假体无菌性松动行二次翻修术外，其余患者臼杯与骨面均无连续性透亮带、假体移位及骨溶解，臼杯均呈骨性固定。结论采用超大生物型臼杯行髋关节翻修术具有操作简便、植骨量少、易恢复髋关节旋转中心等优点，可获得较好疗效。

Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients （35 hips） underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years （range, 47-79 years）. The time from hip arthroplaty to revision was 1-15 years （mean, 9.7 years）. The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture （Vancouver type B3） in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon （AAOS）, 6 cases were classified as type I, 9 cases as type II, and 20 cases as type Ⅲ; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm （mean, 49.6 mm）, and the revision cups had an outside diameter of 56-68 mm （mean, 60.4 mm）. Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years （mean, 8.4 years）. The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4± 3.6 at last follow-up （t=18.76, P=0.00）. The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones （P 〈 0.05）. Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in cup for acetabular revision can achieve good effectiveness for having the good recovery of the acetabular rotation centre.