颗粒松质骨压紧植骨全髋关节置换术治疗创伤性髋关节炎的疗效

目的探讨颗粒松质骨压紧植骨全髋关节置换术(THA)治疗髋臼骨折继发创伤性髋关节炎的疗效。方法1998年12月-2005年5月,对15例髋臼骨折继发创伤性髋关节炎患者行颗粒松质骨压紧植骨THA,所有患者髋臼假体均采用骨水泥固定,颗粒骨均取自体骨,术后24h后开始被动活动,3个月后开始全负重锻炼。临床随访采用Harris髋关节评分(HSS)系统评分,对任何原因引起髋臼假体翻修均视为临床失败。根据Conn等影像学评价法观察颗粒骨长人情况,根据DeLee的三区法测量臼杯、骨水泥与移植骨间的界面宽度,臼杯的移位程度则依据其相对于泪点间线的距离而定。结果14例患者获得平均4．3年(1．0-7．5年)随访,HHS评分由术前平均42分(10-62分)提高到随访结束时平均84分(58-98分)。1例髋部有轻度疼痛,无患者行翻修手术。大部分髋部恢复了其正常的旋转中心,仅有2例高出对侧0．8 mm。大多数患者影像学表现稳定,2例在Ⅰ区和Ⅲ区出现进行性增宽的透亮带,1例在Ⅲ区出现非进行性增宽的透亮带。1例臼杯假体在术后7年出现明显移位(6 mm),但并没有行翻修手术。结论颗粒骨压紧植骨技术作为一种生物学髋臼重建方法,其联合THA治疗髋臼骨折后继发创伤性关节炎伴髋臼缺损的疗效令人满意,能够恢复髋关节的正常解剖和功能活动。

Traumatic coxarthritis treated with bone impaction grafting and total hip arthroplasty

Objective To investigate effects of bone impact ion grafting in combination with total hip arthroplasty (THA) in acetabular reconstruction for patients with posttraumatic arthritis and bone loss after acetabular fractures. Methods From December 1998 to May 2005, 15 consecutive cases of unilateral acetabular fracture were treated with bone impaction grafting and THA in our institution. A cemented polyethylene cup was used in all the patients. In our series all the morselized cancellous bone grafts came from the patients themselves. Passive exercises started 24 hours and full weight-bearing three months postoperatively. Clinical and radiographic assessments were performed according to the Harris Hip Score (HHS) system. A revision of acetabular components for any reason was defined as a clinical failure. The integration of the graft and host bone was evaluated according to the Conn's criteria. Radiolucent lines of more than two mm in width between the cup and the grafts were defined positive in the three zones of DeLee and Charnley. The displacement of the cup prosthesis was evaluated in its relation to the lacrimal point. Results The mean follow-up period was 4. 3 years (range, 1. 0 to 7. 5 years). The average HHS was improved from 42 points (range, 10 to 62 points) preoperatively to 84 points (range, 58 to 98 points) at the final follow-up. One patient felt mild pain in the hip. No revision of the acetabular or femoral component was needed. Most hips regained a normal rotational center, but in two cases the center of the affected side was 0. 8 mm higher than that of the normal side. Most hips presented a stable radiographic change. Progressive radiolucent lines were observed in two cases in Zones One and Three, while a non-progressive radiolucent band appeared in Zone Three in one patient. Seven years after surgery one cup prosthesis had evident progressive displacement of 6mm which was not revised. Conclusions As a biological solution, the morselized bone impaction grafting in combination with THA is an attractive procedure of acetabular reconstruction for patients with posttraumatic arthritis and bone loss after acetabular fractures, because it restores acetabular bone stock, normal hip anatomy and hip function.