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 reconstr...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.展开更多
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 techn...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.展开更多
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 review...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.展开更多
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 aceta...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.展开更多
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...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。展开更多
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...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。展开更多
文摘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.
基金This work is supported by National Key Research and Development Program of China(2016YFC1100600)the National Natural Science Foundation of China(81972058 and 81902194)the Multicenter Clinical Research Project of Shanghai Jiao Tong University School of Medicine(DLY201506).
文摘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.
文摘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.
文摘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.
文摘目的评估利用“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。
文摘目的: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。
