带柄Mc Minn髋臼假体在髋臼翻修中的应用

The stemmed (McMinn) acetabular cup in revision acetabuloplasty

目的 探讨带柄McMinn髋臼假体在伴有严重髋臼骨缺损髋臼翻修术中的应用。方法 1997年3月～ 2 0 0 3年 3月 ,应用带柄McMinn髋臼假体治疗 15例 16髋髋臼骨缺损的翻修病例 ,按美国矫形外科医师学会 (AAOS)分型标准 ,ⅠA型 (节段型缺损周围型 ) 3例 3髋、Ⅲ型 (混合型缺损 ) 12例 13髋。女 11例 12髋 ,男 4例 4髋 ;年龄 6 2～ 78岁 ,平均为 6 9岁。首次翻修 8例 9髋 ,第 2次翻修 7例 7髋。距上次全髋置换时间平均为 8年。带柄杯McMinn髋臼假体为柄杯一体 ,由钛合金材料制成 ,表面多孔 ,杯的表面喷涂羟基磷灰石 ,内衬为超高分子聚乙烯。在杯的周围植入适量异体冻干颗粒骨。结果 随访 3个月～ 6年 ,平均随访 1.4年 ,共随访 12例 13髋。 11髋McMinn柄杯与髂骨结合良好 ,无松动及移位 ,X线摄片显示假体与骨床间无透亮带 ,杯的周围有新骨形成且覆盖假体 ;1髋术后 3年McMinn柄下沉向盆腔内移位 ,取出McMinn假体 ,植入异体颗粒骨结合骨水泥带翼髋臼杯再次翻修 ;1髋McMinn假体与髂骨结合牢固 ,但翻修术后 1年因发生关节不稳而反复脱位 ,需进一步返修。本组翻修成功率为 84 .6 %。翻修前Harris髋关节功能评分为 39.0分 ,术后随访平均为 87.1分。并发症发生率为 12 .5 %。结论 此技术可重建接近正常的髋臼中心 ,

Objective To evaluate the use of a stemmed (McMinn) acetabular cup with morselized bone allograft in treatment of severe acetabular bone insufficiency with revision acetabuloplasty. Methods From March 1997 to March 2003, 15 cases (16 hips) with loosened cup and bone defect were revised by the stemmed uncemented acetabular cups (McMinn) with allograft morselized bone. The acetabular deficiency was classified as follows according to AASO: 3 cases in typeⅠA (segmental peripheral deficiencies), 12 cases (13 hips) in type Ⅲ(combined deficiencies). There were 11 females and 4 males, the average age of the patients was 69 years old (62～78 years). 9 cases underwent revision for the first time, of whom one was revised by McMinn prosthesis on bilateral acetabuloplasties, 7 cases were for the second time. The interval between the last hip arthroplasty and revision on average, was 8 years. The shape of McMinn was a stemmed cup, made of titanium alloy with porous surface coated by HA. The liner was made of UHMPE. Results The mean duration of follow-up was 1.4 years (3 months to 6 years). 12 patients 13 McMinn hips were followed up. Except one, all the McMinn components were firmly fused with the iliac bone, translucent line could not be found between the donor bone bed and McMinn, there was new bone formation around the McMinn cup. The Harris hip score increased from 39.0 points preoperatively to 87.1 points postoperatively. The successful rate of revision was 84.6%. One McMinn stem sunk and was displaced 3 years after revision, and re-revision was performed with morselized bone, cement and acetabular prosthesis with wings. Another case suffered from repeated dislocation one year after revision even though the McMinn component combined well with the iliac bone, this patient need further re-revision. The rate of complication was 12.5%. Conclusions This technique has permitted the hip center to be brought to a near-normal position and it reduces the difficulties of acetabuloplasty revision surgery. The McMinn can give instant stability in the presence of massive bone loss. The revision skill can be reproduced and can improve the successful rate of revision surgery.