摘要
目的探讨髋关节假体周围感染(PJI)一期翻修术中应用钽金属骨小梁髋臼系统(TMARS)重建髋臼缺损的临床效果。方法本研究为回顾性病例系列研究。回顾性分析2013年1月至2021年12月新疆医科大学第一附属医院关节外科诊断为PJI并在一期翻修术中采用TMARS行髋臼缺损重建的59例患者资料。男性32例,女性27例,年龄(59.5±14.6)岁(范围:26~84岁)。其中单纯使用钽杯29例、钽杯联合钽金属加强块13例、髋臼杯联合髋臼加强环罩技术9例、多杯重建技术8例。记录患者手术情况、Harris髋关节评分、髋关节旋转中心恢复情况、植入物存活率及术后并发症情况等。数据比较采用Wilcoxon符号秩检验。结果59例患者均顺利完成手术。手术时间(188.9±48.4)min(范围:110~340 min),术中出血量[M(IQR)]1000(400)ml(范围:600~1800 ml)。术后随访5.1(2.6)年(范围:2.0~10.5年),假体存活率为94.9%(56/59)。发生术后再感染3例(5.1%),无菌性松动1例(1.7%),髋关节脱位4例(6.8%)。末次随访时,HHS较术前明显改善[84(12)分比44(9)分,Z=-6.671,P<0.01],髋关节旋转中心均得到有效恢复。结论TMARS应用于一期翻修重建髋臼缺损,能恢复髋关节的初始稳定,重建相对正常的旋转中心,改善术后髋关节功能,感染复发率较低,是感染髋关节翻修术中重建髋臼缺损的可选方案。
Objective To investigates the clinical efficacy of the trabecular metal acetabular revision system(TMARS)in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection(PJI).Methods This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021.There were 32 males and 27 females,aged(59.5±14.6)years(range:26 to 84 years).Among them,29 cases used tantalum cups,13 cases used tantalum cups and tantalum reinforcing blocks,9 cases used cup-cage,and 8 cases used multi-cup reconstruction techniques.The surgery procedure,Harris Hip score(HHS),recovery of the hip rotation center,implant survival rate,postoperative reinfection rate,and complications were recorded.Data were compared using the Wilcoxon rank-sum test.Results All of the 59 patients underwent the operations successfully.Operation time was(188.9±48.4)minutes(range:110 to 340 minutes),and intraoperative bleeding volume was(M(IQR))1000(400)ml(range:600 to 1800 ml).After a postoperative follow-up of 5.1(2.6)years(range:2.0 to 10.5 years),the prosthesis survival rate was 94.9%(56/59).Recurrence of infection occurred in 3 cases(5.1%),aseptic loosening in 1case(1.7%),and hip dislocation in 4 cases(6.8%).At the last follow-up,HHS improved significantly(84(12)vs.44(9),Z=-6.671,P<0.01),and the center of rotation of the hips were recovered in all cases.Conclusions In one-stage revision surgeries aimed at reconstructing acetabular defects,utilizing the TMARS can provide stable initial fixation,restore a more natural center of rotation,significantly enhance early postoperative hip joint function,and reduce the likelihood of infection recurrence.This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.
作者
薛昭曦
伊力夏提·麦麦提艾麦提
郭文涛
胥伯勇
曹力
Xue Zhaoxi;Maimaitiaimaiti Yilixiati;Guo Wentao;Xu Boyong;Cao Li(Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2024年第9期847-855,共9页
Chinese Journal of Surgery
基金
新疆维吾尔自治区科技计划重大专项项目(2022A03011)
新疆维吾尔自治区科学技术厅科技创新团队项目(2023TSYCTD0014)。
关键词
假体相关感染
关节成形术
置换
髋
假体周围感染
一期翻修
钽金属骨小梁翻修系统
髋臼缺损
Prosthesis-related infections
Arthroplasty,replacement,hip
Periprosthetic joint infection
One-stage revision
Tantalum trabecular metal acetabular revision system
Acetabular deficiencies