改良蛋壳刮除技术在强直髋全髋关节置换髋臼侧重建中的应用及疗效观察

Clinical observation with modified eggshell scraping technique in acetabular side reconstruction of total hip arthroplasty for ankylosed hip

目的探讨改良蛋壳刮除技术在强直髋全髋关节置换髋臼侧重建中的应用疗效。方法2016年3月至2021年3月,荆门市中心医院收治强直髋患者34例(44髋)。其中,男22例,女12例;年龄27~66岁,平均(49.2±9.2)岁;强直性脊柱炎强直髋患者10例,类风湿性关节炎强直髋患者5例,创伤、手术后强直髋患者13例,骨性关节炎强直髋患者5例,感染后强直髋患者1例。对其实施生物型人工全髋关节置换术,术中采用改良的蛋壳刮除技术寻找并重建髋臼,术前、术后各随访时间段记录髋关节Harris评分,测量髋臼重建旋转中心和解剖旋转中心到坐骨结节水平连线的垂直距离,以及重建旋转中心和解剖旋转中心到耻骨联合中线的水平距离。对比分析术前和术后1年髋关节Harris评分,评价髋关节功能;比较重建旋转中心与解剖旋转中心有无差异,检验髋臼假体位置安放的准确性。结果术后34例患者均得到随访,随访时间12~72个月,平均38.03个月,未发生血管神经损伤、感染、血栓、脱位、骨折等并发症。Harris功能评分由术前(36.56±7.31)分提高到术后1年(80.74±4.22)分,差异有统计学意义(P<0.05)。髋关节重建旋转中心垂直距离和水平距离分别为(78.38±8.58)mm和(96.86±9.48)mm,髋关节解剖旋转中心垂直距离及水平距离分别为(77.78±7.63)mm和(98.38±10.62)mm。将髋关节重建旋转中心垂直距离与解剖旋转中心垂直距离比较,差异无统计学意义(P>0.05);重建旋转中心水平距离与解剖旋转中心水平距离比较,差异无统计学意义(P>0.05),综合评估重建的髋臼假体位置良好。结论改良蛋壳刮除技术操作简单,能有效避免术中磨穿髋臼,减少术中透视次数,准确找到真臼并原位重建髋臼,疗效满意。

Objective To investigate the efficacy of the modified eggshell scraping technique for ankylosed hip in the acetabular side reconstruction of total hip arthroplasty.Methods From March 2016 to March 2021,34 ankylosed hip patients(44 hips)were admitted to Jingmen Central Hospital,including 22 males and 12 females,aged from 27 to 66 years,with an average age of(49.2±9.2)years.There were 10 patients with ankylosing spondylitis,5 with rheumatoid arthritis,13 after trauma and surgery,5 with osteoarthritis,and 1 with ankylosing hip after infection.Biological artificial total hip replacement was performed,and a modified eggshell curettage technique was used to locate and reconstruct the acetabulum.Hip Harris score was performed at each preoperative and postoperative follow-up period,the vertical distance from the center of rotation and anatomical acetabular reconstruction to the horizontal line of the sciatic nodules was measured.And the horizontal distance from the reconstructed rotation center and the anatomical rotation center to the midline of the combined pubis bone was also measured.The Harris score of the hip joint one year after surgery was performed to evaluate the hip function.The accuracy of the acetabular prosthesis was compared between the reconstructed and anatomical rotation centers.Results All 34 patients were followed up,without complications such as vascular nerve injury,infection,thrombosis,dislocation,or fracture.The follow-up time was 12 to 72 months,with an average of 38.03 months.The Harris functional score was increased from(36.56±7.31)scores before operation to(80.74±4.22)scores one year after operation,with a significant difference(P<0.05).The vertical and horizontal distances of the hip reconstruction rotation center were(78.38±8.58)mm and(96.86±9.48)mm,respectively,the vertical and horizontal distances of the rotation center of the hip anatomy were(77.78±7.63)mm and(98.38±10.62)mm.The vertical distances of the hip anatomy rotation center and the hip reconstruction rotation center were compared(P>0.05).This showed that the vertical distance of the reconstructed center of rotation was not significantly different from the vertical distance of the anatomical center of rotation.The horizontal distances of the hip anatomy rotation center and the hip reconstruction rotation center were compared(P>0.05).This showed that the horizontal distance of the reconstructed rotation center was not significantly different from the horizontal distance of the anatomical center of rotation.Comprehensive evaluation of the reconstructed acetabular component was well positioned.Conclusion The modified eggshell scraping technique can effectively avoid intraoperative acetabular grinding,reduce intraoperative perspective times,and accurately locate and reconstruct the acetabular in situ.