应用钽金属加强块重建Paprosky Ⅲ型髋臼骨缺损的早期效果

Effects of trabecular metal augments for the reconstruction of Paprosky type Ⅲ acetabulum bone defects

目的探讨钽金属加强块在重建Paprosky Ⅲ型髋臼骨缺损的早期临床效果。方法回顾性分析2014年3月至2016年5月于解放军总医院骨科采用钽金属加强块重建Paprosky Ⅲ型髋臼骨缺损的17例（17髋）患者资料，其中男性6例，女性11例；年龄23～74岁，平均（50.2±16.3）岁；所有患者均采用钽金属加强块或钽金属翻修杯去除钛环后的钽金属臼杯作为加强块（＂杯上杯技术＂）修补缺损。采用Harris评分进行疗效评价，比较手术前后旋转中心的垂直高度，采用Delee－Charnley分区法和Anderson骨长入影像学标准评价术后恢复情况，统计术后并发症。采用配对样本t检验分析手术前后Harris评分。结果所有患者均获得随访，随访时间3～29个月，平均（16.2±5.4）个月。13例采用钽金属加强块联合生物臼杯，4例采用＂杯上杯技术＂。与术前相比，末次随访时Harris总分增加[（86.8±8.3）分比（30.0±12.0）分]（t＝12.78，P〈0.01）；术后患侧旋转中心高度降低[（25.3±9.8）mm比（47.6±10.5）mm]（t＝4.95，P〈0.01）。随访时所有患者臼杯及加强块均稳定，骨长入良好，无感染、脱位等并发症。结论应用钽金属加强块修补Paprosky Ⅲ型髋臼骨缺损效果良好，＂杯上杯技术＂对修补较大的内上方内陷型骨缺损，重建髋关节正常旋转中心有特殊的应用价值。

ObjectiveTo investigate the methods and short-time clinical results of reconstruction of Paprosky type Ⅲ acetabulum bone defects by using tantalum augments.MethodsA total of 17 patients （17 hips） with Paprosky type Ⅲ acetabulum bone defects, treated with tantalum augments in revision of total hip arthroplasty at Department of Orthopedics Surgery in General Hospital of Chinese People′s Liberation Army were retrospectively analyzed from March 2014 to May 2016.There were 6 males and 11 females aged from 23 to 74 years with an average of （50.2±16.3） years. Tantalum augments or TM-Cup augment （the cup-on-cup technique） were used to reconstruct the defects.The TM-Cup augment was the tantalum revision cup which was removed titanium ring. The cup-on-cup technique combined TM-Cup augment and biological acetabulum cup. Augments were served as the nonresorptive structural allograft in revision of total hip arthroplasty. Harris hip score was used to evaluate clinical effects. The vertical position of the rotation center was measured and analyzed. Radiographic assessments of the acetabular components were performed by DeLee-Charnley and the Anderson criteria and recorded postoperative complications.ResultsAll the patients were followed up from 3 to 29 months with an average of （16.2±5.4） months, tantalum augments and biological acetabulum cup were used in 13 patients, the TM-Cup augment and biological acetabulum cup were used in 4 patients. At the time of the latest follow-up, the mean Harris hip score increased compared to preoperatively （86.8±8.3 vs. 30.0±12.0） （t=12.78, P〈0.01）, the average vertical location of the center of rotation was decreased （（25.3±9.8） mm vs.（47.6±10.5）） mm （t=4.95, P〈0.01）. All the tantalum augments and biological acetabulum cups were stable, there were no infection, dislocation and other complications.ConclusionsThe use of tantalum augments could be considered as an effective management of Paprosky type Ⅲ defects providing good clinical and radiographic outcomes in the short term.The cup-on-cup technique which was used in reconstruction of severe superior-invagination acetabular bone defects and restoration relatively normal center of rotation had special application value.