摘要
目的探讨应用深低温冷冻异体颗粒骨打压植骨修复髋臼骨缺损、非骨水泥型髋臼杯重建髋臼的中期疗效。方法1995年4月-2001年12月,对58例62髋行髋臼杯翻修时采用深低温冷冻异体颗粒骨打压植骨修复髋臼骨缺损,非骨水泥型髋臼杯重建髋臼。其中男32例34髋,女26例28髋;年龄(49.6±15.4)岁。左侧32髋,右侧30髋。髋臼翻修原因:髋臼杯无菌性松动56髋,感染性松动3髋,髋臼杯内衬脱落伴严重骨溶解3髋。初次全髋关节置换术至该次髋臼翻修时间为(10.1±3.9)年。术中骨缺损根据美国骨科医师学会分型Ⅱ型42髋,Ⅲ型20髋。根据Harris评分和X线片对其临床结果进行评估。结果术后切口均Ⅰ期愈合,无下肢深静脉血栓发生。58例62髋均获随访,随访时间6～13年,平均8.1年。髋关节Harris评分由翻修术前(61.1±10.2)分提高至末次随访时的(92.0±7.3)分,比较差异有统计学意义(P<0.05),其中优46髋,良10髋,可4髋,差2髋,优良率为90.3%。髋臼杯周围植入异体颗粒骨融合时间为(12.5±4.4)个月。术后髋臼杯内衬每年磨损(0.13±0.09)mm。末次随访时14髋(22.6%)发生髋臼杯假体周围骨溶解,其中2髋线性骨溶解,12髋腔隙性骨溶解。7髋(11.3%)发生异位骨化,根据Brooker法分级Ⅰ级3髋,Ⅱ级3髋,Ⅲ级1髋。其中3髋因髋臼再次翻修或X线片见松动征被评估为髋臼假体翻修术失败,术后8年髋臼假体Kaplan-Meier生存率为94.2%±3.3%。结论选择恰当的髋臼杯翻修适应证,应用深低温冷冻异体颗粒骨打压植骨修复髋臼骨缺损、非骨水泥型髋臼杯重建髋臼,可获得较好的中期疗效。
Objective To evaluate the medium-term results of uncemented acetabular revision with impacted deep frozen morselized allografts. Methods From April 1995 to December 2001, 58 cases （62 hips） were performed acetabular revision by use of deep frozen morselized allograft firmly impacted into localized defects as well as the entire acetabular cavity, followed by insertion of a uncemented cup with supplementary screw fixation. There were 32 males （34 hips） and 26 females （28 hips）, with age of （49.6 ±15.4） years old. Among 62 hips, 32 hips involved in left side and 30 hips involved in right side. The cause of revision was aseptic loosening of the cup in 56 hips, septic loosening of the cup in 3 hips, and polyethylene liner dislodging with severe acetabular osteolysis in 3 hips. The average interval between the primary total hip arthroplasty and the revision was （10.1 ± 3.9） years. According to the American Academy of Orthopaedic Surgeons classification, 42 hips belonged to type Ⅱ and 20 hips to type Ⅲ acetabular defects. The clinical and radiographic results were analyzed postoperatively. Results All wounds healed by first intention. No deep venous thrombosis and infection occurred postoperatively. All patients were followed up 6-13 years （average 8.1 years）. The Harris score was improved from 61.1± 10.2 preoperatively to 92.0 ± 7.3 postoperatively, showing significant difference between preoperation and postoperation （P 〈 0.05）. The results were excellent in 46 hips, good in 10 hips, fair in 4 hips, and poor in 2 hips, the excellent and good rate was 90.3%. The time for allograft incorporation was （12.5 ± 4.4） months after operation. The annual polyethylene liner wear rate was （0.13 ± 0.09） mm. Linear and cavitary osteolysis was observed in 2 and 12 hips, respectively. Heterotopic ossification developed in 7 hips （11.3%）; 3 hips were rated as grade Ⅰ, 3 as grade Ⅱ, and 1 as grade Ⅲ according to Brooker classification. One cup underwent revision for aseptic loos
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第9期1062-1066,共5页
Chinese Journal of Reparative and Reconstructive Surgery
