多孔钽杯及钽金属垫块在PaproskyⅢ、Ⅳ型髋臼缺损翻修中的应用研究

Application of TM cup and tantalum metal pad in revision of Paprosky Ⅲ and Ⅳ acetabular defects

背景：目前接受全髋关节翻修手术患者越来越多，但针对PaproskyⅢ、Ⅳ型髋臼缺损的手术报道仍较少。目的：分析多孔钽杯及钽金属垫块在PaproskyⅢ、Ⅳ型髋臼缺损翻修中的应用效果。方法：采用多孔钽杯及钽金属垫块对28例PaproskyⅢ、Ⅳ型髋臼缺损患者行全髋关节翻修手术。结果：28例患者平均手术时间（103．1±24．9）min，平均术中出血量（260．1±23．8）ml，平均住院时间（14．3±2．6）d，术中未出现严重并发症。随访时间12～36个月，平均（26．3±3．9）个月，末次随访时，Harris评分总分及功能、疼痛、畸形及关节活动度等4项指标均较术前显著提高，有统计学差异（P〈0．001）；末次随访时，28例患者的X线片显示多孔钽杯或钽金属垫块均无位移，并与骨面保持紧密接触，骨缺损部位获得理想填充，植骨整合替代情况满意，于假体周围呈现有辐射状骨小梁密度增加影像，且无假体周围透亮线或骨溶解；所有患者多孔钽杯或钽金属垫块均获得良好骨长入，假体稳定，生存率为100％；术前旋转中心较对侧高3～31mm，平均（13．7±2．5）mm，术后较对侧高0～8Ⅳin，平均（2．6±0．4）mm：术后多孔钽杯外展角43°-56°，平均48.3°±3．2°。结论：多孔钽杯及钽金属垫块在PaproskyⅢ、Ⅳ型髋臼缺损翻修中的应用近期疗效满意，不仅可较好地帮助患者解除疼痛，同时可达到恢复髋关节生物解剖结构及髋关节功能的目的。

Background： More and more patients undergo total hip revision at present. But there are few reports on the oper- ation of the Paprosky Ⅲ-Ⅳ acetabular defect. Objective： To investigate the application of TM cup and tantalum metal pad in revision of Paprosky Ⅲ-Ⅳ acetabular defect. Methods： Twenty-eight patients with Paprosky Ⅲ-Ⅳ acetabular defects were treated with TM cup and tantalum metal pad during revision surgery. Results： The mean operation time was （103.1±24.9） min; the mean intraoperative blood loss was （260.1±23.8） ml; the mean hospital stay was （14.3±2.6） d. No severe com- plications occurred during operation. The patients were followed up for 12-36 months, average （26.3±3.9） months. At the last follow-up, the Harris score and 4 indicators related to function, pain, deformity and joint activities were significantly in- creased compared with preoperative ones （P〈0.001）. The results of X ray showed that the TM cup and tantalum metal pad kept close contact with bone surfaces, satisfactory bone grafts were obtained, and that a radial increased density image was found in periprosthetic bone trabeculae. No displacement, periprosthetic radiolucency or bone dissolution occurred. Good bone ingrowth and stable prosthesis were achieved in all patients, and the survival rate was 100%. Before surgery, the rota- tion center of involved side was higher than contralateral （13.7±2.5） mm on average （range, 3-31 mm）. After surgery, the ro- tation center of involved side was higher than contralateral （2.6±0.4）mm on average （range, 0-8mm）. The mean postopera- tive abduction angle of TM cup was 48.3°±3.2°（range, 43°-56°）. Conclusions： The application of TM cup and tantalum met- al pad in paprosky lll-IVof acetabular defects in revision can achieve satisfactory curative effect. It can help relieve the pain, restore the hip joint anatomical structure and gradually restore the function of hip joint.