髋臼加强环联合同种异体骨植骨髋关节翻修的中期临床疗效观察

Acetabular revision with reinforcement ring and allograft bone grafts: a mid- term effect observation

[目的]观察分析髋臼加强环联合同种异体骨植骨在严重髋臼骨缺损人工髋关节翻修术中的应用及临床疗效,探讨其在髋臼骨缺损重建中的作用。[方法]2010年3月~2015年2月,采用髋臼加强环联合同种异体骨植骨行髋关节翻修75例（87髋）,67例患者79髋获得随访（失随访8例）。男39例,女28例;年龄45~72岁,平均59.2岁。初次置换至此次翻修时间为2~15年,平均10.3年。翻修原因：假体松动和骨溶解。术前髋关节功能Harris评分为（32.5±3.3）分。髋臼骨缺损按照美国骨科医师协会（AAOS）分型标准：Ⅲ型51髋,Ⅳ型28髋。[结果]67例患者79髋获得随访（失随访8例）,随访时间3~60个月,平均32个月。术后切口Ⅰ期愈合,无股神经和坐骨神经损伤、下肢深静脉血栓形成等并发症发生。3例患者术后1个月发生髋关节脱位,2例腰麻下切开复位,1例手法复位后无再脱位。患者术后疼痛症状均明显缓解或消失,末次随访时髋关节Harris评分为（82.5±8.2）分,与术前比较差异有统计学意义（P=0.002）。X线片提示髋臼假体均无骨溶解、松动,所植异体骨与宿主骨融合,未见明显骨吸收区。[结论]采用髋臼加强环联合同种异体骨植骨技术,髋臼假体可获得满意的初始稳定,近期疗效满意,远期疗效尚需进一步观察。髋臼加强环联合同种异体骨植骨可成为严重髋臼骨缺损人工髋关节翻修时重建髋臼的方法之一。

[Objective]To evaluate the effectiveness of acetabulum reinforcement ring with allograft bone graft for reconstructing acetabular defects in hip revision. [Method]From March 2010 to February 2015,75 patients（ 87 hips） with serious acetabular bone defects after total hip arthroplasty underwent acetabular reconstruction by using reinforcement ring with allograft bone graft. Sixty- seven cases（ 79 hips） were followed up for 3- 60 months（ mean,32months）. There were 39 males and 28 females with a mean age of 59. 2 years（ range,45- 72 years）. The mean time between first replacement and revision was 10. 3years（ range,2- 15 years）. The revision causes included osteolysis and aseptic loosening. The hip function Harris score before revision was 32. 5 ± 3. 3. According to America Association of Orthopedic Surgeon（ AAOS） standard,there were type III acetabular defect in 51 hips and type IV in 28 hips. [Result]Sixty- seven cases（ 79 hips） were followed up for 3- 60 months（ mean,32months）. All incisions healed by first intention,and no complication occurred such as nerve trauma,or LDVT. Three cases was found with implant dislocations and received revision. The pain was relieved. At last follow- up,the Harris score was82. 5 ± 8. 2,showing significant difference when compared with preoperative score（ P = 0. 002）. No loosening of the acetabular component or osteolysis was found in 79 hips. No absorption or collapse of the allograft was observed in all patients. [Conclusion]Reinforcement ring with allograft bone is one option for reconstructing acetabular bone defects in hip revision. Long- term outcomes are needed to be observed.