“双杯”技术治疗PaproskyⅢ型髋臼缺损的疗效分析

“Double Cup”Technique:A Reliable Solution for the Treatment of Paprosky TypeⅢAcetabular Defects

目的评估利用“双杯”技术(去除钛环的钽金属翻修臼杯作为增强块)治疗PaproskyⅢ型髋臼缺损的早期临床效果。方法回顾性地分析评估了2017—2023年在中国科学技术大学附属第一医院(安徽省立医院)接受“双杯”技术进行治疗的54例全髋关节翻修术病例。其中男女性患者数量一致,均为27例,年龄30~92岁,平均年龄(65.8±12.3)岁。通过记录患者术前和末次随访时Harris髋关节评分、Oxford髋关节评分和36项健康调查简表(36-item short form survey,SF-36)功能评分来评估临床功能结果;对术前、术后髋关节旋转中心位置和双下肢长度差在影像学上进行评估;评估有无假体松动等术后并发症的发生。结果54例患者均获随访,随访时间为8~80个月,平均(35.3±20.9)个月。术前Harris髋关节评分、Oxford髋关节评分和SF-36功能评分分别为(35.6±10.5)分、(24.4±7.1)分和(805.7±47.5)分,末次随访时分别为(90.6±11.5)分、(44.0±4.2)分和(859.4±47.4)分,患者临床功能结果得到显著改善(P<0.001)。此外,末次随访的影像学结果显示,无论是髋关节旋转中心位置还是双下肢长度差与术前相比都有明显改善(P<0.001),实现了良好的生物力学重建。术后无假体周围感染,6例患者发生假体脱位,但只有1例患者在随访中因假体反复脱位进行了二次手术。结论“双杯”技术是进行PaproskyⅢA和ⅢB型严重髋臼缺损重建的可靠选择,其并发症少、安全性高、功能恢复好,值得在临床上大力推广。

Objective To evaluate the early clinical outcomes of the“Double Cup”technique(titanium ring-free tantalum metal revision cup as an augmentation block)for the treatment of Paprosky TypeⅢacetabular defects.Methods A retrospective analysis was conducted to evaluate the early clinical outcomes of 54 revision cases treated with the“Double Cup”technique for Paprosky TypeⅢacetabular defects at the First Affiliated Hospital of University of Science and Technology of China.from 2017 to 2023.The cohort consisted of 27 male and 27 female patients,with ages ranging from 30 to 92 years[mean age(65.8±12.3)years].Clinical functional outcomes were assessed by recording preoperative and final follow-up Harris hip scores(HHS),Oxford hip scores(OHS),and 36-item short form survey(SF-36)functional scores.Preoperative and postoperative position of the center of rotation(COR)of the hip joint and leg length discrepancy(LLD)were evaluated radiographically.The occurrence of postoperative complications such as prosthesis loosening was also assessed during follow-up.Results All 54 patients were followed up for an average duration of(35.3±20.9)months,ranging from 8 to 80 months.Preoperatively,their HHS,OHS,and SF-36 functional scores were(35.6±10.5),(24.4±7.1),and(805.7±47.5)points,respectively.At the final follow-up,these scores improved significantly to(90.6±11.5),(44.0±4.2),and(859.4±47.4)points,respectively(P<0.001),indicating a marked improvement in hip function and overall health status.Radiographic examinations during the final follow-up revealed substantial improvements in acetabular COR and LLD compared to preoperative values(P<0.001),suggesting successful biomechanical reconstruction.No cases of periprosthetic infection were observed postoperatively.However,6 patients experienced prosthesis dislocation,of which only 1 patient required re-revision surgery due to recurrent dislocation during the follow-up period.Conclusion The“Double Cup”technique indeed represents a viable and reliable surgical option for the reconstruction of severe acetabular defects classified as Paprosky TypeⅢA andⅢB.This technique has demonstrated low complication rates,high safety standards,and promising functional outcomes for patients.Therefore,it is indeed worthy of being actively promoted and considered in clinical practice for patients with these complex acetabular defects.The technique’s ability to effectively restore acetabular anatomy and biomechanics contributes significantly to its success and patient satisfaction.