加强性网杯在人工全髋关节置换术中的应用及其近期随访结果

The application of acetabular reinforcement ring in total hip arthroplasty and its preliminary results

目的评价Burch-Schneider(BS)网杯和颗粒状异体骨打压植骨技术在人工全髋关节置换术中的作用及其近期疗效。方法利用对患者主观症状、患髋客观体征和功能进行评价的评分系统,对9例术后平均3.8年的使用网杯的全髋关节置换或翻修患者评分,按得分情况评价临床效果。结果随访时患者均完全脱拐,能上下楼梯,生活可自理,部分患者行走时跛行和穿袜困难,治疗的优良率为89%。结论(1)加强性网杯重建髋臼适用于存在重度腔洞型和混合型髋臼缺损的全髋关节置换或翻修患者,它是解决严重髋臼缺损的有效方法。(2)BS网杯属生物固定型网杯,网杯和髋臼的骨性愈合为术后良好的远期疗效创造了条件。(3)在骨盆环完整的条件下,BS网杯下翼无须按常规固定于坐骨或耻骨上,可将其自髋臼横韧带上方插入,同时用多枚螺钉固定上翼并使网杯有向外的弹力,这种固定方式的效果最佳。(4)网杯上翼的折弯应顺应髂翼的弧度一次成型,反复折弯易致其断裂或下翼与髋臼横韧带之间松脱,造成网杯与骨床接触不良。(5)在髋臼缺损内填充颗粒状异体骨并压实,植骨颗粒以0.8cm×0.8cm×0.8cm大小为宜,提倡术后早期下床活动。

Objective To evaluate the effects of Burch-Schneider(BS) acetabular reinforcement ring applied in primary or revision total hip arthroplasties in 9 patients with combined or cavitary acetabular bone defects. Methods A retrospective follow up that averaged 3.8 years was performed with a special scoring system comprising the patients symptoms, signs and function. Results The excellent and good function were achieved in 89% of all cases. Conclusion 1)BS reinforcement ring could be effectively and reliably applied in primary or revision total hip arthroplasty or in patients with severe acetabular bone defects. 2)BS reinforcement ring shows the biological fixation feature, so as to provide good foundation for long-term satisfactory function of hip. 3)The lower ear of BS ring need not to be fixed to ischium with screws as usual, but be inserted in obturator foramen above transverse ligament, thus imparting some elastic resilience to it. 4)The upper ear should be folded through such a curve that its curvature was in compliance with that of ilium, which would be better performed in one session. 5)The appropriate amount of 0.8 cm×0.8 cm×0.8 cm morcellized allografting bone was used to snugly fill the space, which would be conducive to desirable incorporation between prosthesis and bone, and the authors propose that the patients should be allowed weight-bearing earlier.