Acetabular Defects of Hip Tuberculosis: Recommended Classification and Reconstruction in Hip Arthroplasty

Background: This study aimed to propose a classification of acetabular defects in advanced-stage hip tuberculosis based on preoperative radiographs and intraoperative evaluation, thereby providing options for reconstructing each type of defect in hip arthroplasty. Materials and Methods: We conducted a prospective study with 45 patients with active hip tuberculosis at stage IV who were treated with a total hip replacement strategy. We collected the patients’ acetabular defect data from preoperative radiographs and intraoperative observations. The defects were classified into types based on defect severity and reconstructive complexity. The hip replacement outcomes were evaluated at least 12 months after the operation. Results: The classification system includes three types: type I: localized or extensive defects inside the acetabulum, not affecting the acetabular rim, medial wall, or columns. Type II: extensive defects inside the acetabulum, affecting the acetabular rim or (and) medial wall. Type III: extensive defects inside the acetabulum, causing the medial wall and the acetabular column to lose function. Each type has a corresponding reconstruction. The outcome includes that 41/45 patients had excellent results;3/45 patients had good results. The patients had good results due to nerve and muscle damage caused by tuberculosis not related to the acetabular defects. Conclusion: This is a simple, practical classification system of acetabular defects in hip tuberculosis. The outcome of hip reconstruction using this classification was excellent without any cases of dislocation or protrusion.

3D Printing Hip Prostheses Offer Accurate Reconstruction,Stable Fixation,and Functional Recovery for Revision Total Hip Arthroplasty with Complex Acetabular Bone Defect

Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.

金属垫块结合Jumbo臼杯在人工髋关节翻修髋臼骨缺损重建中的应用研究

目的:探讨金属垫块结合Jumbo臼杯在人工髋关节翻修髋臼骨缺损重建中的应用效果及影像学变化。方法:回顾性分析2019年9月至2021年10月行人工髋关节翻修髋臼骨缺损重建术的83例患者临床资料,按手术方式不同分两组,42例采用金属垫块结合Jumbo臼杯方式进行翻修为A组,男26例,女16例,年龄44~72(60.57±4.62)岁;41例采用金属垫块联合骨水泥型臼杯进行翻修为B组,男22例,女19例,年龄42~71(58.74±4.25)岁。比较两组手术相关指标,术前及术后1、12个月Harris髋关节功能评分和疼痛视觉模拟评分(visual anagolue scale,VAS);根据X线片评估两组患者术前及术后12个月髋关节旋转中心高度、髋臼外展角、股骨偏心距以及影像学标准合格率,并比较两组并发症发生率。结果:两组手术时间、术中出血量以及术后引流量比较差异无统计学意义(P>0.05)。两组均获得随访,时间12~36(25.36±3.59)个月。两组术后1个月Harris疼痛、功能、畸形评分及总分均高于术前(P<0.05),两组术后12个月Harris疼痛、功能、畸形、关节活动度评分及总分均高于术前和术后1个月(P<0.05),且术后12个月A组Harris各项评分及总分高于B组(P<0.05)。两组术后1、12个月VAS均依次降低(P<0.05),但两组各时间点VAS比较差异无统计学意义(P>0.05)。两组术后12个月股骨偏心距均升高(P<0.05),且A组高于B组(P<0.05);两组术后12个月旋转中心高度及髋臼外展角均降低(P<0.05),且A组旋转中心高度低于B组(P<0.05),但两组髋臼外展角比较差异无统计学意义(P>0.05)。A组的影像学合格率高于B组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论:金属垫块结合Jumbo臼杯治疗髋臼骨缺损可改善髋关节功能,恢复髋关节旋转中心、股骨偏心距以及髋臼外展角,临床效果明显。

“双杯”技术治疗PaproskyⅢ型髋臼缺损的疗效分析

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。

髋关节置换术治疗髋臼骨折继发创伤性关节炎的临床观察

目的:深入研究全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折继发创伤性关节炎的临床疗效。方法:回顾性分析2019年10月至2022年6月,采用THA治疗15例髋臼骨折继发创伤性关节炎患者,男8例,女7例,年龄40~76(59.20±9.46)岁。记录术前及术后假体松动、髋关节脱位、髋关节活动度、神经损伤等情况,采用Harris评分、视觉模拟评分(visual analogue scale,VAS)、影像学检查评价髋关节功能及手术疗效。结果:15例均顺利完成手术,术中无神经、血管损伤,术后切口均Ⅰ期甲级愈合,无感染。随访时间6~39(18.33±9.27)个月。其中1例术后半年发生髋臼侧假体松动,经过翻修手术后恢复良好;1例髋关节脱位,经切开复位处理后治愈,无不良后果。术后末次随访Harris评分(88.60±4.01)分,与术前(47.20±11.77)分相比,差异有统计学意义(P<0.05)。术后末次随访VAS评分1(1)分,与术前8(2)分相比,差异有统计学意义(P<0.05)。末次随访时,本组所有患者疼痛症状减轻或消失,关节功能满意;末次随访影像学资料显示关节假体贴合良好,无异位骨化发生,假体无松动。结论:THA治疗髋臼骨折继发创伤性关节炎疗效可靠,能有效提高患者的生活质量。术前对患者全面评估、骨缺损评估,术中髋臼、股骨、内固定物与骨缺损的处理是手术成功的关键因素。

髋臼外缘缺损对髋臼假体初始稳定性影响的有限元研究

目的通过三维有限元方法探索行全髋关节置换术中生物型臼杯置入时初始稳定的髋臼缺损临界条件。方法利用计算机软件重建骨盆三维模型,设计不同的髋臼外缘缺损,并分别对不同的缺损模型进行力学加载,计算出不同缺损模型下髋臼杯的覆盖率以及臼杯相对宿主骨的临界微动位移。结果当α=-25°时,臼杯相对宿主骨的最大微动位移为39μm,髋臼覆盖率为67.1%,此时达到臼杯稳定的临界值。结论采用生物性假体进行全髋关节置换术时,在无额外固定条件下,应保持髋臼杯骨覆盖率不低于67.1%,以保证正常步态下置入髋臼杯的初始稳定性。

Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up

AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software(IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the KaplanMeier method.RESULTS The mean follow-up was 87.6 ± 25.6 mo(range 3-120 mo). 25 cases(43.1%) were classified as minor defects, and 33 cases(56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1(range: 29-53) before revision, to a mean of 85.8 ± 6.1(range: 70-94) at the end of the follow-up(Student's t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect(Student's t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants(6.9%). Postoperative acetabular gaps were observed in 5 hips(8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95%(for all reasons) and 100% for aseptic loosening of the acetabular component.CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

髋关节置换髋臼骨缺损的评估与重建选择

髋臼骨缺损的发病率逐年升高,病因多种多样,最常见于人工全髋关节置换术后。其治疗手段虽然在不断变化、更新,但成人髋臼骨缺损导致髋关节局部解剖变异及生物力学和继发性骨性关节炎的异常使手术难度增高,其手术处理一直是临床骨科医师面临的重大挑战。成人髋臼骨缺损修复重建成功的关键在于术前对缺损髋臼进行精准评估、选择合适的手术方式和正确的缺损重建假体。本文就髋臼骨缺损的病因、术前准备和计划、分型及重建手术方式进行综述。

Jumbo Bionic Trabecular Metal Acetabular Cups Improve Cup Stability During Acetabular Bone Defect Reconstruction:A Finite Element Analysis Study

The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.

应用个性化生物臼杯进行髋关节翻修的近期评估

背景:随着接受人工全髋关节置换的患者越来越多,出现髋臼侧松动伴不同程度骨缺损的患者日趋增加,治疗方式有多种,包括结构植骨、颗粒植骨加钛网重建、钽金属垫块重建、Jumbo杯、Cup-Cage技术等。目的:总结个性化生物臼杯翻修全髋关节置换后髋臼侧松动的近期临床疗效,为髋关节翻修提供一种可行的方法。方法:选择2017年3月至2019年3月解放军第九八九医院平顶山医疗区收治的全髋关节置换后髋臼侧松动11例患者,其中男7例,女4例;年龄55-71岁,均采用个性化生物臼杯进行髋臼侧翻修并进行3年随访,记录术前和末次随访的髋关节Harris评分、目测类比评分和双下肢绝对长度差,观察X射线片表现,评估髋关节功能恢复状态和骨长入情况。结果与结论:(1)所有患者均由同一医生主刀完成,随访满3年,无丢失病例,其中1例出现坐骨神经症状,口服甲钴胺片,6个月恢复;(2)末次随访的髋关节Harris评分、目测类比评分和双下肢绝对长度差与术前比较,差异有显著性意义(P <0.05);(3)末次随访X射线片显示有良好的骨长入;(4)结果表明,应用个性化生物臼杯翻修全髋关节置换后髋臼侧松动可获得假体的初始稳定性、恢复理想的关节功能和较好的骨长入,为髋关节翻修提供一种可行的方法。

3D打印个体化反折包埋式髋臼假体治疗成人Crowe Ⅳ DDH患者的临床观察

目的 探讨3D打印技术下个体化反折包埋式髋臼假体在治疗成人Crowe Ⅳ发育性髋关节发育不良(developmental dysplasia of the hip, DDH)患者的应用。方法 对20例成人Crowe Ⅳ DDH患者根据三维CT数据,制作骨盆3D打印模型,在模型上模拟全髋关节置换时的髋臼,采用藻酸盐印模材料修复髋臼缺损,定制个体化髋臼假体,术中采用手术方案与术前模拟操作一致。记录髋臼假体型号、手术时间、术中出血量、术后Harris评分、VAS评分及术后并发症的发生率。结果 术中使用髋臼假体型号与定制髋臼假体一致,3D打印组手术时间、术中出血量、术后Harris评分、VAS评分、术后并发症发生率均优于常规组。结论 3D打印技术下个体化反折包埋式髋臼假体在成人CroweⅣDDH患者进行THA手术时修复髋臼缺损优势明显,增加髋臼假体稳定性,减少手术时间、术中出血及术后并发症,明显改善髋关节功能,提高了手术效率和准确性,值得临床应用与推广。

22例全髋关节翻修术中对髋臼骨缺损的处理

目的探讨全髋关节翻修术中髋臼骨缺损的处理经验。方法回顾分析22例全髋关节翻修术中对髋臼骨缺损的处理经验,研究植骨、固定、髋臼置换和功能康复的新方法。结果本组手术全部成功,术后无感染发生。随访6-58个月,平均22.6个月,随访时关节无疼痛,对手术结果满意,髋关节功能较术前显著改善。结论（1）王爱民提出的新的骨缺损分类法简单清晰,能更好的指导髋臼重建手术。（2）对节段性和混合性骨缺损大块植骨时应辅以颗粒骨,并尽量选用较稳固的钉板系统固定。（3）使用带缝匠肌髂骨瓣植入重建髋臼缺损为活骨移植,成骨较好。

全髋关节翻修术中髋臼缺损的重建

目的 :在全髋关节翻修术中 ,通过打压植骨、髋臼钢板或金属钛网对髋臼骨缺损进行重建 ,以恢复髋臼的完整性 ,提高髋臼假体的稳定性。 方法 :全髋关节翻修术 38例 ,其中 12例采用自体或异体骨植骨、髋臼重建钢板或金属钛网固定 ,对重建后的髋臼进行支撑和加强。 结果 :12例患者术后随访 3～ 38(平均 13.1)个月 ,X线片表明髋臼侧植骨处仅 1例出现轻度骨吸收 ,其余骨愈合良好 ,未出现骨吸收和内固定移位。 结论 :对于髋关节翻修中 ,对髋臼骨缺损者采用打压植骨、髋臼钢板或金属钛网支撑加强 ,重建髋臼的骨性结构是一种有效的方法 。

人工全髋关节置换术中非感染性髋臼骨缺损的治疗策略

目的探讨人工全髋关节置换术在治疗非感染性髋臼骨缺损中的应用。方法 2000年1月至2010年1月间40例非感染性髋臼骨缺损初次行全髋关节置换患者,其中CroweⅢ、Ⅳ型先天性髋关节脱位18例,髋关节感染后融合14例,陈旧性髋臼骨折8例。内移髋关节旋转中心17例,结构性植骨13例,颗粒松质骨打压植骨10例;有14例应用钛网,9例重建钢板,7例加强杯固定。术前术后进行临床评估及X线评估。结果本组手术全部成功,术后无感染发生。本组40例患者随访8～42个月,平均(10.4±2.1)个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善,术前平均Harris评分为(58.4±6.1)分,术后为(88.6±3.1)分;术后平均Harris评分较术前提高明显,两者比较差异有统计学意义(P<0.05)。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨并辅以颗粒骨,并选用牢固的钉板系统固定,将髋臼重建在真臼位置,并尽量采用非骨水泥型臼杯,通过不同的重建方法可以获得良好的髋关节功能。

打压植骨结合结构性植骨重建成人髋臼发育不良性骨缺损

目的：探讨全髋置换术中应用打压植骨结合结构性植骨在重建成人髋臼发育不良（developmentaldysplasiaofhip，DDH）性骨缺损中的疗效。方法：回顾性分析2007年1月-2012年6月，在我科治疗的成人DDH11例患者，发育不良按Crowe分型为Ⅱ型5例，Ⅲ型6例：骨缺损按美国骨科医师学会分类术前均为Ⅲ型混合型缺损。3例用同种异体股骨头，8例用自体股骨头进行结构性植骨。均用2、3枚螺钉固定。1例用骨水泥型带加强环的臼杯，10例用非骨水泥型带螺旋臼杯压配固定。均取股骨侧髓腔或自体髂骨碎粒打压植骨。术中不同程度松解髋周组织。结果：所有患者顺利完成手术，无1例感染。经6～48个月的随访，未发现关节疼痛、臼杯松动。Harris评分由术前的平均39．7分（18～52分）提高到术后末次随访时的平均85．7分（52—96分）。结论：结构性植骨及合适的臼杯能提供髋臼骨缺损的结构性即时支撑，打压植骨颗粒能提供充足的骨量支持从而促进臼杯与骨床的融合。

缝匠肌髂骨瓣翻转固定修复髋臼缺损治疗发育性髋脱位

目的总结缝匠肌骨瓣翻转固定修复髋臼缺损治疗发育性髋脱位的初步疗效。方法 18例(20髋)髋臼严重缺损性发育性髋脱位,均行关节囊切开复位、股骨近端粗隆间短缩内翻旋转截骨角钢板固定、带缝匠肌髂骨瓣翻转螺钉固定髋臼缺损修复术,术后双下肢贝氏石膏固定1.5个月。按McKay临床功能及Severin X线标准进行疗效评价。结果 16例(18髋)患儿取得完整随访资料,随访时间为4-37个月,平均22.8个月。患儿18例均为女性,年龄4-13岁,平均6.1岁。McKay临床功能评定、Severin X线标准评定,优良率均为89%。结论缝匠肌髂骨瓣翻转固定修复髋臼缺损为活骨移植,成骨效果好,愈合快,对难处理的髋臼严重缺损性发育性髋脱位治疗有效。

缝匠肌骨瓣修复人工全髋关节置换中髋臼缺损的实验研究

目的建立缝匠肌骨瓣修复人工全髋关节置换(THR)中髋臼节段性缺损的动物模型,并观察其初步修复结果。方法16只成年山羊进行左侧THR,并造成髋臼上方负重区40%的节段性骨缺损。随机分成2组,分别以缝匠肌髂骨瓣和游离髂骨瓣移植修复,术中行骨瓣血运、带血管蒂缝匠肌骨瓣活动长度的观察,术后行大体、X线和组织学观察。结果术中缝匠肌髂骨瓣血运良好,有足够的活动长度;术后X线显示移植骨块及置换假体位置良好,固定牢靠;缝匠肌髂骨瓣仍然保持基本正常松质骨结构,与髋臼可以形成类似骨折愈合的连接。结论缝匠肌骨瓣可以很好地修复髋臼节段性缺损,效果优于游离骨瓣。

个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损的有限元分析

目的建立个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损有限元模型,分析个性化3D打印多孔钛合金加强块、螺钉以及骨的生物力学和临床应用安全性。方法利用1例PaproskyⅢA型髋臼骨缺损病人的骨盆CT数据建立完整的个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损有限元模型,模拟1倍体重(单足站立)、4倍体重(步行)和6倍体重(慢跑)加载负荷下分析加强块、螺钉以及骨的应力分布。结果个性化3D打印多孔钛合金加强块的最大应力分布为10.130 MPa(1倍体重)、40.706 MPa(4倍体重)和61.213 MPa(6倍体重),固定加强块的螺钉最大应力分布为12.424 MPa(1倍体重)、50.250 MPa(4倍体重)和75.860 MPa(6倍体重),骨面应力分布最大应力分布为10.439 MPa(1倍体重)、42.627 MPa(4倍体重)和64.554 MPa(6倍体重)。结论有限元模拟术后即刻完全负重站立时所有部件的应力分布均小于其屈服强度,不会发生失效;但是于步行和慢跑加载负荷下,与加强块和螺钉接触骨面的部分区域松质骨会发生失效。因此从有限元分析角度考虑,病人术后即刻可以进行完全负重站立康复锻炼,但是不能进行完全负重的步行或慢跑康复运动。

人工髋关节置换术治疗非感染性髋臼骨缺损:附42例报告

目的探讨人工髋关节置换手术在非感染性髋臼骨缺损的治疗经验。方法回顾性分析42例人工髋关节置换术对非感染性髋臼骨缺损的处理结果,探讨植骨、固定和髋臼置换的方法。结果本组手术全部成功,术后无感染发生。随访6～63个月,平均33.4个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨时应辅以颗粒骨,并选用牢固的钉板系统固定,并尽量采用非骨水泥型臼杯,短期疗效好。