打压植骨联合钛网治疗髋关节翻修术中髋臼缺损疗效的中长期随访

Mid-long term follow-up of impaction bone grafting and Ti-alloy mesh for acetabular deficiency in revision total hip arthroplasty

[目的]观察打压植骨联合钛网治疗髋关节翻修术中髋臼缺损的中长期疗效。[方法]2005年1月~2008年12月间,对24例需行髋关节翻修患者采用打压植骨联合钛网重建髋臼缺损,男7例,女17例,平均年龄67岁（58~75岁）,初次置换距翻修手术平均8.1年（3~16年）,髋臼缺损按Paprosky分型：ⅡC型15例,ⅢA型9例,翻修均选用同种异体骨及骨水泥假体,术后及随访时进行X线评估及Harris评分。[结果]24例患者术后平均随访7.1年（5~9年）,术后早期均未见感染、脱位、假体周围骨折等并发症。截止至末次随访除1例再次翻修外均未发生假体松动及再行翻修治疗。患者Harris评分由术前平均38分（12~56分）增至末次随访时的86分（81~92分）。[结论]对于Paprosky分型ⅡC及ⅢA型髋臼骨缺损,打压植骨结合钛网固定技术可获得较满意的中长期疗效。

[Objective]To investigate the mid- long term follow- up of impaction bone grafting and Ti- alloy mesh for acetabular deficiency in revision total hip arthroplasty. [Method]From January 2005 to December 2008,24 patients with acetabular deficiency were treated with impaction bone grafting and Ti- alloy mesh total hip arthroplasty,including 7 males and 17 females,the average age were 67 years（ 58- 75 years）. The average time from Initial arthroplasty to revision was 8. 1 years（ 3- 16years）. According to the Paprosky classification scheme,15 cases belonged to type ⅡC and 9 cases belonged to type ⅢA. Allogeneic bone and cemented prosthesis were used in the revision surgery. The X- ray as well as the Harris hip score during postoperative and follow- up were evaluated. [Result]All 24 patients were followed up for an average of 7. 1years（ 5- 9years）. No infection,dislocation,periprosthetic fractures and other complications were observed during early postoperative. Until last follow- up,no prosthetic loosening and revision took place except for one case. Harris scores were raised from preoperative 38 points（ 12- 56 points） to the last follow- up 86 points（ 81- 92 points）.[Conclusion]For Paprosky types IIC and IIIA acetabular bone defect,impaction bone grafting combined with Ti- alloy mesh can acquire satisfactory mid-long term efficacy.