摘要
目的评估运用大号生物型臼杯(Jumbo臼杯)翻修髋臼骨缺损的早期临床疗效。方法回顾性分析了山东省立医院骨关节外科2010年4月至2014年12月期间经治的人工全髋置换术后存在不同程度髋臼骨缺损的33例患者(33髋),其中男15例,女18例,年龄平均(60±7)岁。31例患者为单侧初次翻修,2例患者为单侧二次翻修。翻修原因:不同程度骨溶解伴假体松动32例,髋关节置换术后感染1例。髋臼骨缺损按Paprosky分型,其中ⅡA型6例,ⅡB型8例,ⅡC型7例,ⅢA型6例,ⅢB型6例。其中7例采用双锥面螺旋臼(63~72)mm进行翻修,26例采用大号(52~68)mm钽金属臼杯联合颗粒性打压植骨、螺钉固定进行翻修。术后随访采用Harris髋关节评分标准评估髋关节翻修术后功能,影像学检查来观察假体位置、有无假体周围骨溶解及移植骨愈合情况,使用SPSS 19.0统计学软件包对手术前后计量指标进行配对t检验。结果 33例患者均获得随访,平均随访(22±11)个月。术前Harris评分平均(37±7)分,术后末次随访平均(84±4)分;不同Paprosky分型患者末次随访和手术前Harris评分比较有显著改善,差异有统计学意义(均为P<0.05)。X线检查未发现臼杯松动或内固定移位,植骨愈合良好,仅有一例出现轻微骨吸收现象。患者术后疼痛消失或基本消失,无假体脱位、感染、排异反应、神经损伤等并发症出现。结论对于髋关节翻修术中存在髋臼骨缺损的患者,根据其缺损情况应用Jumbo臼杯联合打压植骨可为髋臼假体提供早期稳定,其短期随访效果良好。
Objective To investigate the early clinical effects of large uncemented acetabular component（ Jumbo cups） in treatment of acetabular deficiencies during the revison of total hip arthroplasty（ THA）. Methods The retrospective study included 33 cases（ 33 hips） for acetabular deficiency after THA from April 2010 to December 2014. There were 15 males and 18 females,whose average age was（ 60 ± 7） years. Primary revision was performed on 31 patients,while the other patients accepted secondary revision. As to the reason of acetabular revision,there were 32 cases caused by aseptic loosening,one case caused by infection after THA. According to the Paprosky acetabular defect classification,there were six hips of type Ⅱ A,eight hips of type Ⅱ B,seven hips of type Ⅱ C,six hips of type Ⅲ A and six hips of type ⅢB. Among them,seven cases were repaired with double cone spiral cups（ 63 ~ 72） mm,and 18 cases with trabecular metal（ TM） acetabular cups（ 52 ~ 68） mm,combining with impaction grafting of morselized bone graft and screw fixation. The Harris hip score was used to evaluate the hip function. X-ray imaging was used to observe the position of the prosthesis,estimate the periprosthetic osteolysis and bone graft healing. The SPSS 19. 0 statistical software package was used to perform the paired t test between the preoperative and postoperative groups. Results All the patients were followed up for a mean period of（ 22 ± 11） months. The average preoperative Harris hip score were（ 37 ± 7）,and the postoperative score were（ 84 ± 4）; all the different Paprosky type groups presented statistically significant improvement in Harris sore comparing the preoperative ones and the ones at last follow-up（ all P 0. 05）. X-ray imaging showed no acetabular cup loosening or displacement of internal fixation,and only one case showed slight bone absorption. During the follow-up, the postoperative pain disappeared completely or mostly; no complication was observed（ such as dislocation,infe
出处
《中华关节外科杂志（电子版）》
CAS
2017年第4期84-89,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
假体和植入物
钽
关节成形术
置换
髋
再手术
骨移植
随访研究
Prostheses and implants
Tantalum
Arthroplasty
replacement
hip
Reoperation
Bone transplantation
Follow-up studies
