人工全髋关节置换术中非感染性髋臼骨缺损的治疗策略

目的探讨人工全髋关节置换术在治疗非感染性髋臼骨缺损中的应用。方法 2000年1月至2010年1月间40例非感染性髋臼骨缺损初次行全髋关节置换患者,其中CroweⅢ、Ⅳ型先天性髋关节脱位18例,髋关节感染后融合14例,陈旧性髋臼骨折8例。内移髋关节旋转中心17例,结构性植骨13例,颗粒松质骨打压植骨10例;有14例应用钛网,9例重建钢板,7例加强杯固定。术前术后进行临床评估及X线评估。结果本组手术全部成功,术后无感染发生。本组40例患者随访8～42个月,平均（10.4±2.1）个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善,术前平均Harris评分为（58.4±6.1）分,术后为（88.6±3.1）分;术后平均Harris评分较术前提高明显,两者比较差异有统计学意义（P〈0.05）。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨并辅以颗粒骨,并选用牢固的钉板系统固定,将髋臼重建在真臼位置,并尽量采用非骨水泥型臼杯,通过不同的重建方法可以获得良好的髋关节功能。

Effect of Acetabular Reconstruction in Primary Total Hip Arthroplasty for Non-infectious Acetabu- lar Defects

Objective To explore the effect of acetabular reconstruction in primary total hip arthroplasty（THA） for non-infectious acetabular defects. Methods Forty patients with non-infectious acetabular defects were treated by THA between January 2000 and January 2010.18 cases suffered from Growe Type- Ⅲ and Ⅳ congenital hip disloca- tion, 14 cases from post-infection hip ankylosis ,and 8 cases from delayed acetabular fracture. 17 cases were treated by THA combined with inside movement of the rotating center,13 cases with structural auto-grafting,and 10 cases with impaction bone grafting with morselised bone. The grafting bone was fixed by Ti-alloy mesh in 14 cases ,reconstructed plate in 9 cases and acetabular reinforcement device in 7 cases. Clinical and radiological evaluations were conducted for each patient both pre-operation and post operation. Results The operations were performed successfully in all the 40 cases. No infection happen post-operatively. All the 40 cases were followed up from 8 months to 42 months with an average of（10.4±2.1 ） months. No prothetic loosening happen in all series. No joint pain happen in all series. The hip function improved remarkably. The mean Harris score was（58.4±6.1）pre-operatively, （88.6±3.1） post-operative- ly. The difference of the mean Harris score had statistical significance between in pre-operation and post-operation（P〈0.05）. Conclusion For segmental and fusion defects of non-infectious acetabulum,massive bone grafting should be combined with morselized bone and plate screw system. The acetabular rotating center should be reconstructed in the true place. Uncemented acetabular cup should be paid much more attention during the treatment of hip arthroplasty. Satisfactorv hip function could be achieved through different reconstruction methods.