同种异体骨颗粒填塞植骨联合Jumbo臼杯在中重度髋臼骨缺损髋关节翻修中的应用

Application of Jumbo Cup combined with allogeneic bone squeezing and bone grafting in hip joint revision of moderate-severe acetabular bone defect

目的观察大号生物杯(Jumbo臼杯)联合同种异体骨颗粒填塞植骨在全髋关节翻修术中对中重度髋臼侧骨缺损进行重建的疗效。方法收集我院2011年9月至2016年6月,采用Jumbo臼杯联合颗粒同种异体骨颗粒填塞植骨重建26例(26髋)中、重度髋臼骨缺损髋关节翻修患者的临床资料。男13例,女13例,年龄35~81岁,平均(62.3±12.4)岁。初次人工全髋关节置换术至翻修术间隔1~25年,平均8.42年。髋关节翻修原因:无菌性松动24例,假体周围感染2例。骨缺损根据Paprosky分型标准,IIA型7例,IIB型7例,IIC型11例,IIIA型1例。评价术前、术后的髋关节Harris评分、疼痛视觉模拟评分(visual analogue scale,VAS);在X线片上评价髋关节旋转中心、髋臼外展角、股骨偏心距以及植骨融合情况,并判断髋臼有无松动和移位、生存率情况及并发症。同种异体股骨头由山西奥瑞公司提供。结果全部病例均获得随访,随访时间24~83个月,平均53.3个月。Harris评分:术前(51.88±3.41)分,末次随访(85.38±3.47)分(P<0.05);VAS评分:术前(6.23±0.91)分,术后(0.62±0.63)分(P<0.05);患侧髋关节旋转中心高度:术前(3.26±0.96) cm,末次随访(2.67±0.64) cm (P<0.05);患侧髋臼外展角:术前(50.68±7.88)°,术后(40.75±5.56)°(P<0.05);股骨偏心距:术前(41.54±6.13)°,术后(46.39±7.57)°(P<0.05)。随访期内Jumbo臼杯固定良好,未出现松动及移位,髋臼杯均出现不同程度骨长入,均未发现臼杯周围透光线、骨溶解,假体生存率100.0%。结论在髋关节翻修中使用Jumbo臼杯联合同种异体骨颗粒填塞植骨治疗髋臼侧骨缺损能提供早期稳定性,尽可能恢复股骨偏心距、髋关节旋转中心及骨量储备,短期随访临床效果良好。

Objective To observe effects of Jumbo Cup combined with allogeneic bone squeezing and bone grafting on hip joint revision of moderate-severe acetabular bone defect.Methods Clinical data of 26 patients(26 hips)were collected.All underwent total hip arthroplasty revision with the Jumbo Cup combined with allogeneic bone grafting to reconstruct the acetabular bone defect in our hospital from September 2011 to June 2016.There were 13 males and 13 females,aged 35-81 years(mean:62.3±12.4 years)old.The interval of primary total hip arthroplasty to revision surgery was 1-25 years,with an average of 8.42 years.Causes of hip revision:aseptic loosening(24 cases);infection around the prosthesis(2 cases).According to the Paprosky classification criteria,bone defects were found in 7 cases of type IIA,7 cases of type IIB,11 cases of type IIC,and 1 case of type IIIA.The preoperative and postoperative hip Harris scores and visual analogue scale(VAS)were evaluated.The hip rotation center,acetabular abduction angle,femoral offset and bone graft fusion were evaluated on X-ray films to determine acetabulum loosening or displacement,prosthesis survival rate and surgical complications.The allogeneic femoral head was provided by Shanxi OsteoRad Co.,Ltd.Results All patients were followed up for 24-83 months with an average of 53.3 months.The preoperative Harris score was(51.88±3.41),which increased to(85.38±3.47)at he last follow-up(P<0.05).The preoperative VAS score was(6.23±0.91),which reduced to(0.62±0.63)postoperatively(P<0.05).The preoperative height of the hip joint rotation center was(3.26±0.96)cm,which reduced to(2.67±0.64)cm at the last follow-up(P<0.05).Preoperative acetabular abduction angle was(50.68±7.88)°,which reduced to(40.75±5.56)°postoperatively(P<0.05).Preoperative femoral eccentricity was(41.54±6.13)°,which increased to(46.39±7.57)°(P<0.05).Jumbo cup was well fixed during the follow-up,no loosening or displacement occurred.Bone ingrow in the acetabular cup was observed.No light transmission line or osteolysis around the cup was found.The survival rate of the prosthesis was 100.0%.Conclusions Reconstruction of acetabular bone defect in total hip arthroplasty revision with large biological acetabular cup(Jumbo cup)combined with allogeneic bone grafting can provide early stability and restore femoral offset.The hip rotation center and bone mass are reserved.Short-term follow-up shows good clinical effects.