使用金属骨小梁髋臼和组配重建柄对伴严重骨缺损的松动人工髋关节进行翻修的治疗结果

Results of revision total hip arthroplasty by using trabecular metal acetabular cup and restoration modular stem protheses in patients with severe bone defects

目的:探讨应用金属骨小梁(TM)髋臼和组配重建柄(RM)对使用金属对聚乙烯(MOP)界面发生无菌性松动的患者进行髋关节翻修的早期结果。方法:回顾性分析2015年6月至2018年6月因无菌性松动而行髋关节翻修术的47例患者。男24例,女23例,平均年龄(61.7±12.5)岁,体重指数(23.6±3.5)kg/m^(2),从初次置换到行翻修术间隔平均时间为(148.6±76.3)个月,根据骨缺损Paprosky分型:髋臼侧Ⅲ型24例,股骨侧Ⅲ型29例。应用TM臼翻修髋臼侧,RM翻修股骨侧,分析翻修手术的临床以及影像学结果。结果:所有患者术后平均随访(39.3±11.0)个月。与术前相比,末次随访时所有患者Harris评分显著提高[(82.4±13.2)分比(47.3±11.4)分,P<0.001]。有3例症状性深静脉静脉血栓形成,应用抗凝药物治疗后血栓溶解。1例患者术后脱位,闭合复位以及姿势保护后未再复发。无术后感染、血肿、坐骨神经受损发生。所有患者末次随访时X线检查显示假体无松动。对于髋臼侧骨缺损PaproskyⅢ型患者,未使用垫块患者的旋转中心比健侧位置平均高出(13.1±4.4)mm,使用垫块患者平均高出(2.8±3.2)mm(P<0.01)。股骨假体术后下沉1.0 mm(0~3.0 mm),均发生于术后1年内,至末次随访时再无进展。下肢不等长为6.2(-13.2,10.6)mm。结论:使用TM假体和RM翻修柄处理无菌性松动的髋关节翻修术短期结果满意,对于髋臼侧严重骨缺损使用金属垫块可以获得更好的旋转中心重建效果。

Objective: To evaluate the short-term results of revision total hip arthroplasty(THA) by using trabecular metal(TM) acetabular cup and restoration modular(RM) stem prostheses in aseptically loosened THA with metal-on-polyethylene(MOP) bearing surfaces. Methods: We retrospectively analyzed 47 patients undergoing revision THA from June 2015 to June 2018 due to aseptic loosening. There were 24 males and 23 females with an average age of(61.7±12.5) years. Their mean BMI was(23.6±3.5) kg/m^(2). The mean interval from primary THA to revision was(148.6±76.3) months. There were 24 patients with Paprosky type Ⅲ acetabular bone defects and 29 with Paprosky type Ⅲ femur defects. Clinical and radiological results of these revision THAs were assessed. Results: The mean follow-up time was(39.3±11.0) months. The Harris Hip Score of the patients at the last follow-up was significantly higher than that before surgery(82.4 ± 13.2 vs 47.3 ± 11.4, P<0.001). Symptomatic deep venous thrombosis was observed in 3 patients and treated by anticoagulants. One patient had early dislocation and were treated by close reduction without recurrence. No postoperative infection, hematoma, sciatic nerve damage or loosening occurred. For patients with Paprosky type Ⅲ acetabular defects, the rotation center of patients using augments was(2.8±3.2) mm higher than the healthy side on average, which was significantly lower than that without using augments([13.1±4.4] mm, P<0.01). The median postoperative subsidence of the femoral prostheses was 1.0 mm(0-3.0 mm), which occurred within one year after the operation, and no progress had been found until the last follow-up. The median length of lower extremity inequality was 6.2(-13.2, 10.6)mm. Conclusions: The short-term results of revision THA for aseptic loosening using TM shells, augments and RM stems are satisfactory. Metal augments can help to restore the biomechanics in patients with severe acetabular bone defects.