异体颗粒松质骨移植治疗髋臼杯稳定的髋臼周围骨溶解Morselized bone grafting in osteolysis around the stable cenmentless acetabular cup
廉永云;Myung-chul Yoo;裴福兴;冯卫;Yoon-Je Cho;Sung-Wook Chun;
摘要(Abstract)：
[目的]评价异体颗粒松质骨移植治疗THA术后髋臼杯稳定的髋臼周围骨溶解的效果。[方法]自1996年4月~2000年7月,对26例髋臼杯周围骨溶解而假体稳定者行保留髋臼杯,清除病灶、异体颗粒松质骨移植术,并更换聚乙烯内衬和股骨头假体。术后平均随访5.5 a。对临床结果、骨溶解病变范围和骨移植愈合分别用Harris髋关节评分系统、放射线影像学和骨移植愈合分级系统进行评价。[结果]Harris评分由翻修术前的平均82分增加到术后平均88分;X线片示髋臼杯周围骨溶解范围正位由术前23.8 mm×24.9 mm减小到术后11.5 mm×8.2 mm,侧位由术前的11.1 mm×11.6 mm减少到术后5.3 mm×4.5 mm;异体骨愈合程度Ⅰ级12例(46%),Ⅱ级14例(54%)。[结论]保留髋臼杯、清除病灶后行异体颗粒松质骨移植术是非骨水泥髋臼杯稳定的髋臼周围骨溶解治疗的有效措施,可以保留更多的髋臼骨量,降低手术的复杂程度。
关键词(KeyWords)： 非骨水泥髋臼杯;骨溶解;人工全髋关节翻修术;异体骨;颗粒型骨移植
基金项目(Foundation):
作者(Author): 廉永云;Myung-chul Yoo;裴福兴;冯卫;Yoon-Je Cho;Sung-Wook Chun;
Email:
DOI:
参考文献(References)：
- [1]Berry D J.Managem ent of osteolysis around total h ip arthrolasty[J].O rthoped ics,1999,22(9):805-808.
- [2]D Anton io JA,CapelloWN,Borden LS.C lassification and managem entof acetabu lar abonormalities in total h ip arthroplasty[J].C lin O rthop,1989,243:126-137.
- [3]Eric RB,Christian PC,Eric AM,et al.Particu late bone grafting of os-teolytic femoral lesions around stab le cem entless stem[J].C lin O r-thop,2000,381:58-67.
- [4]MaloneyW J,Herzwurm P,PaproskyWG,et al.Treatm ent of pelvic os-teolysis associated w ith a stab le acetabu lar component inserted w ithoutcem ent as part of a total h ip replacem ent[J].J.Bone Joint Surg,1997,79:1628-1634.
- [5]Paprosky WG,Perona PG,Lawrence JM.Acetabu lar defect classifica-tion and surgical reconstruction in revision arthroplasty:a 6 year fol-low-up evaluation[J].J Arthoplasty,1994,9:33-44.
- [6]Rubash HE,S inha RK,Maloney W J,et al.Osteolysis:surgical treat-m ent[J].Instr Course Lect,1998,350:128-137.
- [7]Schmalzried TP,Fowb len VA,Am stutzHC.The fate of pelvic osteolys-is after reoperation:no recurrence w ith lesional treatm ent[J].C lin O r-thop,1998,350:128-137.
- [8]DwLee JG,Charn ley J.Rad iological demarcation of cem ented socketsin total h ip replacem ent[J].C lin O rthop,1976,121:21-32.
- [9]Livermore J,Dauane.E ffect of femoral head size on wear of the polyeth-ylene acetabular component[J].J Bone Joint Surg,1990,72:518-528.
- [10]Eva G rimau,Luc Soub igou,Séverine Cou illaud,et al.Receptor activa-tor of nuclear factor KB ligand(RANKL)/osteoprotegerin(OPG)ratiois increased in severe osteolysis[J].Am erican Journal of Pathology,2003,163:2021-2031.
- [11]Schmalzried TP,Guttman D,G recu la M,et al.The relationsh ip be-tween the design,position,and articu larwear of acetabu lar componentsinserted w ithout cem ent and the developm ent of pelvic osteolysis[J].JBone Joint Surg,1994,76:677-688.
- [12]Ahlmann E,Patzak is M,Roid is N,et al.Comparision of anterior andposterior iliac crest bone grafts in term s of harvest-site morb id ity andfunctional outcom es[J].J Bone Joint Surg AM,2002,84:716-720.
- [13]Stevenson S.The immune response to osteochonderal allgrafts[J].JBone Joint Surg,1987,69:573-582.
- [14]Van der Donk S,Buma P,Slooff TJ,et al.Incorporation of morselizedbone grafts:a study of 24 acetabu lar b iopsy specim ens[J].C lin O r-thop,2002,396:131-141.