赵亮;史哲;吴宣平;王健;肖军;史占军;

• 1:南方医科大学南方医院关节与骨病外科
• 2:新疆医科大学第一附属医院关节外科
• 3:南方医科大学附属第三医院骨关节外科

摘要(Abstract)：

[目的]观察分析髋臼加强环联合同种异体骨植骨在严重髋臼骨缺损人工髋关节翻修术中的应用及临床疗效,探讨其在髋臼骨缺损重建中的作用。[方法]2010年3月~2015年2月,采用髋臼加强环联合同种异体骨植骨行髋关节翻修75例(87髋),67例患者79髋获得随访(失随访8例)。男39例,女28例;年龄45~72岁,平均59.2岁。初次置换至此次翻修时间为2~15年,平均10.3年。翻修原因:假体松动和骨溶解。术前髋关节功能Harris评分为(32.5±3.3)分。髋臼骨缺损按照美国骨科医师协会(AAOS)分型标准:Ⅲ型51髋,Ⅳ型28髋。[结果]67例患者79髋获得随访(失随访8例),随访时间3~60个月,平均32个月。术后切口Ⅰ期愈合,无股神经和坐骨神经损伤、下肢深静脉血栓形成等并发症发生。3例患者术后1个月发生髋关节脱位,2例腰麻下切开复位,1例手法复位后无再脱位。患者术后疼痛症状均明显缓解或消失,末次随访时髋关节Harris评分为(82.5±8.2)分,与术前比较差异有统计学意义(P=0.002)。X线片提示髋臼假体均无骨溶解、松动,所植异体骨与宿主骨融合,未见明显骨吸收区。[结论]采用髋臼加强环联合同种异体骨植骨技术,髋臼假体可获得满意的初始稳定,近期疗效满意,远期疗效尚需进一步观察。髋臼加强环联合同种异体骨植骨可成为严重髋臼骨缺损人工髋关节翻修时重建髋臼的方法之一。

关键词(KeyWords)： 髋关节翻修;髋臼骨缺损;髋臼重建;髋臼加强环

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵亮;史哲;吴宣平;王健;肖军;史占军;

Email:

DOI:

参考文献(References)：

• [1]Hall A,Eilers M,Hansen R,et al.Advances in acetabular reconstruction in revision total hip arthroplasty:maximizing function and outcomes after treatment of periacetabular osteolysis around the wellfixed shell[J].J Bone Joint Surg Am,2013,95(18):1709-1718.
• [2]Schreurs BW,Keurentjes JC,Gardeniers JW,et al.Acetabular revision with impacted morsellised cancellous bone grafting and a cemented acetabular component:a 20-to 25-year follow-up[J].J Bone Joint Surg Br,2009,91(9):1148-1153.
• [3]Paprosky WG,Cross MB.CORR Insights:Validity and reliability of the Paprosky acetabular defect classification[J].Clin Orthop,2013,471(7):2266.
• [4]Weeden SH,Paprosky WG.Porous-ingrowth revision acetabular implants secured with peripheral screws.A minimum twelve-year follow-up[J].J Bone Joint Surg Am,2006,88(6):1266-1271.
• [5]Issack PS.Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty[J].J Bone Joint Surg Am,2013,95(21):1981-1987.
• [6]Bicanic G,Barbaric K,Bohacek I,et al.Current concept in dysplastic hip arthroplasty:Techniques for acetabular and femoral reconstruction[J].World J Orthop,2014,5(4):412-424.
• [7]Philippe R,Gosselin O,Sedaghatian J,et al.Acetabular reconstruction using morselized allograft and a reinforcement ring for revisionarthroplasty with Paprosky typeⅡandⅢbone loss:survival analysis of 95 hips after 5 to 13 years[J].Orthop Traumatol Surg Res,2012,98(2):129-137.
• [8]Krishnan KM,Longstaff L,Partington P.Acetabular reconstruction using morcellised bone with ring support-medium-term results at three to nine years[J].Acta Orthop Belg,2011,77(1):61-67.
• [9]刘王卫,杨静,裴福兴,等.髋臼加强环联合同种异体骨植骨重建髋臼在髋关节翻修中的应用[J].中国修复重建外科杂志,2012,26(8):902-904.
• [10]Winkler H,Stoiber A,Kaudela K,et al.One stage uncemented revision of infected total hip replacement using cancellous allograft boneimpregnated with antibiotics[J].J Bone Joint Surg Br,2008,90(12):1580-1584.
• [11]Schreurs BW,Luttjeboer J,Thien TM,et al.Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis.A concise follow-up,at eight to nineteen years,of a previous report[J].J Bone Joint Surg Am,2009,91(3):646-651.
• [12]Te Stroet MA,Rijnen WH,Gardeniers JW,et al.Satisfying outcomes scores and survivorship achieved with impaction grafting for revision THA in young patients[J].Clin Orthop,2015,473(12):1-9.
• [13]Thien TM,Chatziagorou G,Garellick G,et al.Periprosthetic femoral fracture within two years after total hip replacement:analysis of 437,629 operations in the nordic arthroplasty register association database[J].J Bone Joint Surg Am,2014,96(19):167.