非骨水泥人工全髋关节置换术中髋臼骨缺损重建方式选择及对臼杯位置影响的研究

RECONSTRUCTION MODE SELECTION OF ACETABUL AR BONE DEFECT AND EFFECT ON ACETABULAR CUP POSITION IN CEMENTLESS TOTAL HIP ARTHROPLASTY

目的 探讨非骨水泥人工全髋关节置换术（total hip arthroplasty,THA）中髋臼骨缺损对重建方式选择及臼杯位置的影响。方法 回顾分析2008年2月-2014年2月符合选择标准的78例（78髋）行非骨水泥THA的髋臼骨缺损患者,其中后上壁缺损且缺损面积〈30%者39例,行后上方打压植骨（A组）;后上壁缺损且缺损面积30%～50%者24例,行后上方结构性植骨或植入钽金属垫块（B组）;内壁缺损且缺损面积〈30%者10例,行腔隙内打压植骨（C组）;内壁缺损且缺损面积30%～50%者5例,行内壁钛网重建结合打压植骨（D组）。A、B组间和C、D组间患者性别、年龄、侧别等一般资料比较,差异均无统计学意义（P〉0.05）。比较术后臼杯外展角、前倾角及实际旋转中心与真实旋转中心的水平、垂直距离。结果 术后患者均获随访,随访时间7～25个月。术后A组2例发生假体松动;B组1例坐骨神经损伤,1例髋关节脱位。术后即刻和末次随访测量示：A、B组实际旋转中心和真实旋转中心的水平距离和垂直距离比较,差异均无统计学意义（P〉0.05）;C、D组水平距离比较差异有统计学意义（P〈0.05）,垂直距离差异无统计学意义（P〉0.05）。A组臼杯外展角、前倾角与B组比较,差异有统计学意义（P〈0.05）;C、D组以上指标比较,差异无统计学意义（P〉0.05）。结论 髋臼后上壁骨缺损时,重建方式会影响臼杯外展角和前倾角;髋臼早期松动可能与外展角过大、重建方式选择不当有关。髋臼内壁骨缺损时,旋转中心均有不同程度上移,重建方式会影响旋转中心的水平位移。

Objective To investigate the reconstruction mode selection of acetabular bone defect and the effect on the acetabular cup position in cementless total hip arthroplasty （THA）. Methods A retrospective analysis was made on the clinical data of 78 patients （78 hips） with acetabular bone defect according to the selection criteria who underwent THA between February 2008 and February 2014. In 39 cases having acetabular posterosuperior bone defect with defect area less than 30%, impaction bone grafting was performed （group A）; in 24 cases having acetabular posterosuperior bone defect with defect area of 30%-50%, structural bone or tantalum block grafting was performed （group B）; in 10 cases having acetabular medial wall bone defect with defect area less than 30%, impaction bone grafting was performed （group C）; and in 5 cases having acetabular medial wall bone defect with defect area of 30%-50%, titanium mesh combined with impaction bone grafting was performed （group D）. There was no significant difference in gender, age, and side between groups A and B, and between groups C and D （P〉0.05）. The acetabular abduction angle, anteversion, the horizontal and vertical distances of actual and true rotation center after operation were compared. Results The patients were followed up 7-25 months. Prosthesis loosening occurred in 2 cases of group A, sciatic nerve injury and hip joint dislocation in 1 case of group B, respectively. At immediate after operation and last follow-up, there was no significant differences in the horizontal or vertical distance of actual and the true rotation center between groups A and B （P〉0.05）; significant difference was found in the horizontal distance between groups C and D （P〈0.05）, but no significant difference in the vertical distance （P〉0.05）. Difference was statistically significant in the acetabular abduction angle and anteversion between groups A and B （P〈0.05）, but difference was not significant between groups C and D （P〉0.05）. Conclusion In patients with acetabular posterosuperior bone defect, reconstruction methods will have effect on acetabular abduction and anteversion; early acetabulum prosthesis loosening may be associated with too large acetabular abduction angle and inappropriate reconstruction methods. In patients with acetabular medial wall bone defect, the vertical distances of rotation center will shift upward in varying degrees, and reconstruction methods have effect on the horizontal distances of rotation center.