髋臼骨缺损髋关节置换31例

目的 探讨非感染性髋臼骨缺损的人工髋关节置换经验。方法 回顾分析31例非感染性髋臼骨缺损的髋关节置换经验，研究植骨、固定、髋臼置换和功能康复的新方法。本组男18例，女13例；年龄23—73岁，平均55．5岁。根据美国骨科学会(AAOS)的分类方法：节段型骨缺损5例，空腔型骨缺损7例，混合型骨缺损5例，骨折型骨缺损6例，关节融合型骨缺损8例。结果 本组手术全部成功，术后无感染发生。手术后随访24例，随访时间6—68个月，平均24．3个月，随访时关节无疼痛，对手术结果满意，髋关节功能较术前显著改善。结论 (1)对节段型和混合型骨缺损，大块植骨时应辅以颗粒骨，并尽量选用较稳固的钉板系统固定。(2)使用带缝匠肌髂骨瓣植入重建髋臼缺损为活骨移植，成骨较好。(3)建议对髋臼非感染性骨缺损的髋关节置换尽量采用非骨水泥型臼杯。

Total hip arthroplasty for acetabular defects in 31 cases

Objective To discuss management experience in total hi p arthroplasty for noninfectious acetabular defects. Methods Thirty-one cases (18 males and 13 females; at age of 23-73 years, mean 55.5 years) with acetabular defects treated with total hip arthroplasty were retrospe ctively analyzed so as to study the fresh method for bone grafting, fracture fix ation, hip arthroplasty and functional recovery. According to American Associati on of Orthopaedic Society (AAOS), there were 5 cases of segmental acetabular def ects, 7 cavity acetabular defects, 5 mixed defects, 6 acetabular fractures and d efects and 8 fusion acetabular defects. Results The operati ons succeeded in 31 cases without any postoperative infection. The mean follow- up was 24.3 months (6-68 months) in 24 cases, in which the hip function improv ed and the operative result was satisfactory with no joint pain. Concl usions (1) For segmental and fusion defects, morselized bone should b e used together with structure bone grafting. The plate and screw system should be used as possible. (2) As a kind of vital bone grafting, the pedicle sartorius muscle iliac bone grafting for reconstruction of acetabular defects can attain better bone formation. (3) Uncemented acetabular implant-cup should be paid muc h more attention to during the treatment of noninfectious acetabular defects wit h hip arthroplasty.