髋关节翻修中骨盆不连续的评估与重建

Evaluation and management of chronic pelvic discontinuity in revision total hip arthroplasty

随着接受全髋关节置换术的患者数量不断增加及术后假体生存期不断延长,各种原因导致全髋关节置换术后假体固定失败翻修病例数量也在不断上升。全髋关节置换术后因各种原因导致失败者接受翻修时最主要的问题是存在不同程度的骨缺损,其中慢性骨盆不连续是髋臼翻修中最复杂、最严重的骨缺损,也是髋臼翻修最复杂、最具挑战性的难题。髋臼残余骨量、髋臼骨床成骨能力、骨盆不连续的愈合是决定治疗成功的三大要素。对慢性骨盆不连续患者进行精确的术前评估和计划,根据不同的骨缺损特点选择同种异体骨植骨结合非骨水泥半球形臼杯、髋臼植骨结合防内突髋臼重建杯、半球形非骨水泥臼杯结合多孔金属垫块、Cup-cage技术、定制型三翼髋臼假体重建技术或骨盆牵引结合多孔钽金属杯重建等技术,是目前骨盆不连续重建的常用方法。

Revision total hip arthroplasty is becoming more common due to an increasing number of primary total hip arthroplasty procedures being performed annually.Chronic pelvic discontinuity is an important and difficult complication after primary total hip arthroplasty.It is estimated that chronic pelvic discontinuity account for 1%-5%of all acetabular revisions.Pelvic discontinuity occurs mostly in female patients or patients with a history of prior pelvic radiation or rheumatoid arthritis.There are three following crucial factors in regards to achieving satisfied outcomes in treating pelvic discontinuity,the amount of bone stock remaining,biologic in-growth potential and the healing potential of the discontinuity.Treatment approaches include cage reconstruction with bulk acetabular allograft,custom triflange acetabular component,a cup-cage construct,jumbo acetabular cup with porous metal augments,and acetabular distraction with a porous tantalum shell with or without modular porous augments.The present course reported the classification,evaluation,reconstruction options and outcomes of chronic pelvic discontinuity.