颗粒骨植骨在髋臼翻修中的应用

Application of morselized bone grafting for the revision of loosened acetabular component

目的 介绍采用颗粒骨 (morselized bone)移植和国产带三翼髋臼假体行髋臼翻修术的体会。方法 1989年 12月～ 1999年 6月采用自体或异体颗粒骨植骨，行髋臼假体松动并骨缺损翻修 23例。男 12例，女 11例；年龄 38～ 71岁，平均 54.2岁。初次全髋关节置换使用的假体 :双杯关节置换 4例，全髋关节置换 19例。骨水泥固定 22例，非骨水泥固定 1例。按 Gustillo分型 :Ⅱ 型 3例，Ⅲ型 9例，Ⅳ型 11例。术中取髂骨自体颗粒骨 6例，异体冷冻干燥颗粒骨 17例，颗粒骨的直径为 4～ 6 mm。髋臼假体 :旋入型金属髋臼 2例，螺钉固定型金属髋臼 10例，国产带三翼金属髋臼 11例。带三翼金属髋臼结构为珍珠面金属髋臼的外上象限向心性分布三个翼，翼底与金属髋臼为一体，翼的游离缘为利刃，刃高分别为 10、 15、 20和 25 mm四个型号 ,内衬为超高分子聚乙烯。结果 术后伤口均一期愈合。随访最短 1年 2个月，最长 8年 1个月，平均 3年 8个月。除 3例外，自体或异体颗粒骨均愈合良好。 X线检查 :假体包容满意，假体与骨床间无 X线透亮区，原骨缺损得以修复。翻修前 Harris评分平均为 47分，术后随访平均为 86分，翻修成功率为 86.9％。术后再松动者 3例中 2例因假体放置位置不当，植骨不充分，固定不牢致松动，其中

Objective To report the experience of the revision procedure with morselized bone grafting and a special design of acetabular prosthesis with three wings for loosened acetabular component in our hospital. Methods Since December 1989 to Junanry 1999, 23 cases with loosened acetabular component and bone defect were revised by morselized bone auto/allografting. There were 12 males and 11 females, the average age of the patients was 54.2 years old (range from 38 to 71 years old). The prosthesis of primary THA was double cup in 4 cases, the conventional THA in 19 cases, cemented in 22 cases and cementless in 1 cases. The severity of acetabular component loosening was classified into four types according to Gustillo: Type II in 3 cases, type III in 9 cases and type IV in 11 cases. The morselized bone autografting and allografting with size 4－ 6 mm were used in 6 cases and in 17 cases respectively. Different acetabular components had been used, the thread metal acetabular cup in 2 cases, screw fixed conventional metal acetabular cup in 10 cases and special design acetabular prosthesis with three wings in 11 cases. The latter prosthesis consists of an conventional acetabular component with pearl porous surface and three wings with different length and sharp edge distributed centrally in the superior lateral quadrant on the surface, the liner is made of UHMPE. Results No infection of the wound occurred in this group. The mean time of follow- up was 3 years and 8 months. Except 3 cases, all of the bone grafts was healed well and X－ ray showed that the containing of acetabular component was good, no translucent line between donor bone bed and prosthesis, and the bone defect had been repaired. The average Harris score was 47 before revision, and 86 after revision. The successful rate of revision was 86.9％ . There were 3 loosening cases postoperatively, 2 cases were due to incorrect position of prostheses and insufficient bone graft, another case was due to the screw being too short to fix the acetabular component. However, all of the three cases have partial bone growth in the original loosening acetabular. Conclusion 1. Direct contact between the morselized bone auto/allograft and the surface of metal acetabular component and the firm fixation of the prosthesis have showed good result of bone defect reconstruction. 2. The special design of acetabular prosthesis with three wings could be selected as an alternative method for huge bone loss of acetabulum (ranged from 64 to 79 mm), because it was able to enlarge the volume of the acetabular component.