髋臼加强环联合同种异体骨植骨重建髋臼在髋关节翻修中的应用

目的总结髋臼加强环(Cage)联合同种异体骨植骨重建髋臼在髋关节翻修术中的应用及疗效。方法 2006年2月-2010年8月,对14例(14髋)行人工全髋关节翻修术的重度髋臼骨缺损患者采用Cage联合同种异体骨植骨重建髋臼。男6例,女8例;年龄45～76岁,平均59.2岁。初次置换至此次翻修术时间为5～12年,平均7.2年。翻修原因:感染8例,骨溶解及假体松动6例。术前髋关节功能Harris评分为(37.7±5.3)分。髋臼骨缺损按照美国骨科医师协会(AAOS)分型标准:Ⅲ型8例,Ⅳ型6例。结果术后切口均Ⅰ期愈合,无坐骨神经损伤、下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间14～62个月,平均44个月。患者疼痛症状均明显缓解或消失。末次随访时髋关节Harris评分为(89.7±3.2)分,与术前比较差异有统计学意义(t=—44.40,P=0.04)。X线片示髋臼假体均无松动,植骨未见明显吸收,并逐渐与宿主骨融合。结论在髋关节翻修时,采用Cage联合同种异体骨植骨能有效修复髋臼骨缺损并重建髋臼,近期疗效满意,远期疗效尚需进一步随访观察。     

髋臼加强环联合同种异体骨植骨在髋臼骨缺损人工髋关节翻修术中的应用

目的探讨髋臼加强环联合同种异体骨植骨在髋臼骨缺损人工髋关节翻修术中的应用效果。方法随机将48例髋臼骨缺损行人工髋关节翻修术的患者分为2组,各24例。对照组术中采用同种异体骨植骨术,观察组在对照组基础上联合使用髋臼加强环。结果随着随访时间的延长,2组髋关节功能Harris评分均随之增高。但观察组明显高于对照组,且并发症率明显低于对照组。差异均有统计学意义(P0.05)。结论髋臼加强环联合同种异体骨植骨进行髋臼骨缺损的人工髋关节翻修,术后并发症率低,效果可靠。     

髋臼加强环在严重髋臼骨缺损人工髋关节置换中的应用

目的 总结髋臼加强环在严重髋臼骨缺损的人工髋关节翻修术及初次置换术中的应用及疗效. 方法 2000年11月-2005年7月,采用髋臼加强环联合自体或异体骨移植治疗14例15髋伴严重髋臼骨缺损的人工髋关节置换患者.男7例7髋,女7例8髋;年龄34～72岁,平均55岁.行翻修术9例9髋,距初次置换时间3～22年,平均8.9年;初次置换术5例6髋,双髋类风湿关节炎、髋臼发育不良继发骨性关节炎、髋关节感染清创股骨头切除术后、髋臼陈旧骨折不愈合伴股骨头中心脱位、髋臼陈旧骨折不愈合各1例.病程2～25年,平均11.6年.髋臼骨缺损根据AAOS分型:Ⅱ型7髋,Ⅲ型6髋,Ⅳ型2髋.术前Harris评分(59.1±15.4)分. 结果 术后切口均Ⅰ期愈合.1例于麻醉恢复后出现坐骨神经刺激症状,神经营养药物治疗5个月症状缓解.14例患者均获随访,随访时间33～90个月,平均51.3个月.末次随访时Harris评分为(81.9±10.4)分,与术前比较差异有统计学意义(P<0.01).X线片示加强环聚乙烯移位均<5 mm,旋转角度均<5°,髋臼侧及螺钉周围无进行性放射透亮带. 结论 髋臼加强环有助于重建严重骨缺损的髋臼,改善患者髋关节功能,为臼杯植于理想生物力学位置提供早期稳定.     

同种异体颗粒骨打压植骨联合不同类型假体在严重髋臼骨缺损翻修中的应用

目的探讨对严重髋臼骨缺损患者采用同种异体颗粒骨打压植骨联合骨水泥型或非骨水泥型假体翻修的早中期疗效。方法回顾分析2011年2月-2018年5月采用同种异体颗粒骨打压植骨联合假体翻修治疗的42例(44髋)严重髋臼骨缺损患者临床资料,其中采用骨水泥型臼杯24例(24髋)、非骨水泥型臼杯18例(20髋)。男17例,女25例;年龄22~84岁,平均62.8岁。初次人工全髋关节置换术距该次翻修术时间为2.5~12.0年,平均8.3年。翻修原因:假体无菌性松动31例(32髋),假体周围感染11例(12髋)。按照髋臼骨缺损Paprosky分型标准:ⅢA型28例(29髋),ⅢB型14例(15髋)。术前髋关节Harris评分为(22.25±10.31)分。髋关节旋转中心高度为(3.67±0.63)cm,双下肢长度差值为(3.41±0.64)cm。结果手术时间为130~245 min,平均186 min。术中出血量600~2400 mL,平均840 mL。术后引流量250~1450 mL,平均556 mL。术后1例出现切口浅表感染,其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6~87个月,平均48.6个月。末次随访时Harris评分为(85.85±9.31)分,与术前比较差异有统计学意义(t=18.563,P=0.000)。影像学复查显示同种异体骨与宿主骨逐步融合,未见明显骨吸收。末次随访时,髋关节旋转中心高度为(1.01±0.21)cm,与术前比较差异有统计学意义(t=17.549,P=0.000);双下肢长度差值为(0.62±0.51)cm,与术前比较差异有统计学意义(t=14.211,P=0.000)。与术前相比,末次随访骨水泥组、非骨水泥组Harris评分明显提高,髋关节旋转中心高度下降且均在Ranawat三角内,双下肢长度差值亦减小,差异均有统计学意义(P<0.05);两组髋关节旋转中心高度比较差异有统计学意义(t=2.095,P=0.042),Harris评分及双下肢长度差值比较差异无统计学意义(P>0.05)。结论对于PaproskyⅢ型髋臼骨缺损患者,根据缺损程度选择同种异体颗粒骨打压植骨联合骨水泥型或非骨水泥型假体翻修,均可有效重建髋关节,并获得较好的早中期疗效。     

人工髋关节髋臼侧骨缺损翻修

在人工全髋关节置换术 3～ 5年以上 ,有明显骨吸收而骨缺损 ,特别是髋臼侧有严重的骨溶解性骨缺损 ,不得不行髋臼骨结构性重建 ,是全髋关节翻修术面临的艰巨课题。因此 ,进行有效骨缺损修复 ,成功的髋部骨结构重建 ,是人工髋关节髋臼侧骨缺损翻修的关键。其中并不包括因假体设计缺陷、假体周围骨折松动、假体安置位置失当导致脱位、松动等原因引起的翻修问题。1　髋臼骨缺损的分类1.1　ＡＡＯＳ改进分类法分为 5类 :Ⅰ型 :髋臼骨节段性骨缺损 ,其又分为二种亚型 :ⅠＡ　边缘性髋臼骨缺损 ;ⅠＢ　中央性髋臼内壁骨缺损。Ⅱ型　髋臼腔隙性骨缺…     

全髋关节置换术后髋臼缺损的翻修疗效观察

目的观察全髋关节置换术后髋臼侧骨缺损的翻修疗效。方法对13例全髋关节置换术后髋臼侧骨缺损的患者实施翻修治疗,回顾性分析患者的影像学特点、临床表现及治疗资料。结果术后平均随访1.8 a。平均Harris评分由术前52分,提高到末次随访时91分。末次随访时13髋均获得良好的稳定性,未出现松动及移位,髋臼周围未见透亮线,假体生存率100%。按照Anderson骨长入影像学评价标准,髋臼杯均出现不同程度骨长入。结论全髋关节置换术后髋臼骨缺损更换较大直径臼杯,选择同种异体颗粒骨结合金属骨小梁模块置入,或髋臼加强杯翻修是解决髋臼侧骨缺损的有效手段,近期疗效好,远期疗效尚待进一步随访。     

人工髋关节翻修术中髋臼骨缺损的重建方法

随着全髋关节置换手术的普及,人工髋关节翻修术的数量也呈逐年增加的趋势.髋臼骨缺损的重建是髋关节翻修的难点.在进行全面术前评估和计划的同时,科学、合理的分型和选用合适的技术对实现髋臼的成功重建至关重要.生物型髋臼杯、骨小梁金属垫块等新方法显著改善了髋臼重建效果,3D打印等新技术也为髋臼重建提供了新的有效手段.     

人工髋关节翻修术中对髋臼骨缺损的处理

随着人工髋关节置换技术的广泛开展,因各种原因需进行人工髋关节翻修术的患者日渐增多。人工髋关节翻修术的目的是解除疼痛和恢复髋关节功能。一般可通过重建髋关节的解剖结构和更换假体来实现。在翻修过程中,可选用骨水泥或非骨水泥假体来获得坚强的固定。但那些由于磨损、磨损所产生的碎屑以及炎症产生的骨溶解而导致的骨缺损,常常使翻修术变得很困难。其中髋臼骨缺损是经常遇到的难题。对髋臼骨缺损的充填,需要充足的库存骨和各种类型的假体,并且要求手术医师熟悉股骨前、后方的手术入路,能充分显露骨盆,对各种并发症能及时处理。本文就…     

自体骨植骨技术结合金属网杯重建髋臼骨缺损在全髋关节翻修术中的应用及效果分析

目的 探讨自体骨植骨技术结合金属网杯重建髋臼骨缺损在全髋关节翻修术中的应用及其效果. 方法 以因严重髋臼骨缺损、需要行全髋关节翻修术的15例患者为研究对象,均取自体同侧髂骨修复髋臼骨缺损,并以金属网杯重建髋臼.观察患者的手术情况,至少随访1年观察术后各时点的临床表现、髋关节Harris评分和X线片特征. 结果 全部患者均顺利完成手术,切口均Ⅰ期愈合;术后住院期间未发生感染、出血及假体松动和移植失败等并发症.平均随访（1.3±0.1）年,功能恢复良好;术后即刻、术后6个月、术后1年各时间点的髋臼假体的倾斜角、假体股骨头中心水平和垂直距离比较,差异均无统计学意义（F=0.23～0.96,P＞0.05）.未出现髋臼侧假体松动的情况;术前、术后6个月及术后1年时的髋关节Harris评分分别为（40.5±6.5）分、（65.2±5.0）分、（91.0±3.7）分,相邻时间段Harris评分比较,差异均具有统计学意义（t6=9.61,t12=7.90,P＜0.01）. 结论 自体骨植骨技术结合金属网杯重建髋臼缺损可能是全髋关节翻修术的一种较好方法,术后患者骨缺损修复和固定效果确切,功能恢复满意,对全髋关节翻修具有一定的指导借鉴意义.     

颗粒骨打压植骨结合非骨水泥臼固定在髋臼翻修中的应用

目的 探讨颗粒骨打压植骨结合非骨水泥臼在髋臼翻修中的临床应用.方法 应用颗粒骨打压植骨结合非骨水泥臼技术重建髋臼骨缺损10例,术中使用异体颗粒骨直径4～6 mm,髋臼假体均为生物型髋臼,上2或3枚螺钉固定,内衬均为高交联聚乙烯.结果 切口均一期愈合,无感染、脱位等并发症发生.随访9～28个月,平均19.5个月,X线片上髋臼骨床、颗粒骨及假体界面未见明显透亮带存在,原骨缺损区修复良好.Harris评分术前平均38.1分,术后平均85.5分.结论 颗粒骨打压植骨结合非骨水泥臼固定方法可有效修复髋关节翻修中髋臼AAOSⅡ、Ⅲ型骨缺损,恢复骨量,并能提供良好的早期稳定性.     

Acetabular revision using acetabular roof reinforcement ring with a hook

This study evaluated the clinical and radiographic results of 37 acetabular revisions using an acetabular roof reinforcement ring with a hook (ARRRH). The average age of the patients was 52.4 years, and the mean follow-up period was 4.5 years. The mean Harris hip score had improved from 49 points preoperatively to 87 points at the final follow-up. The bone graft was radiographically incorporated in all cases. The postoperative complications were a hip dislocation in 3 cases, nonunion of the greater trochanter in 1, infection in 1, discomfort at the autograft donor site in 3, and 2 cases of hook failure. An ARRRH combined with a morsellized bone graft is a useful treatment particularly in moderate-to-severe acetabular bone deficiencies.     

Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone

A retrospective review of 25 patients who underwent 28 acetabular revisions with the Burch—Schnieder antiprotrusio cage (Protek, Berne, Switzerland) and cancellous allograft bone was performed. Follow-up periods averaged 33 months. Patients had averaged 2.1 prior operations per hip. Twenty-two hips had American Academy of Orthopaedic Surgeons type III (combined segmental and cavitary bone loss) acetabular deficiency. Five hips had type II (cavitary bone loss) and one hip had type I (segmental bone loss) acetabular deficiency. After surgery, 80% of the patients had mild or no pain and 80% functioned as at least a community ambulator. Radiographic analysis included a detailed study of implant migration and the degree to which the hip center and bone stock were restored. Significant component migration was documented in 14% of the acetabular reconstructions. The hip center was improved from a preoperative side-to-side difference of 12.5 mm to 4.9 mm at final evaluation (P = .01). Average medial wall bone stock was improved from 1.9 mm before surgery to 10.1 mm postrevision (P < .01). No patients required revision of the antiprotrusio cage for problems related to the acetabular reconstruction. For failed acetabular components associated with moderate to massive bone loss, the antiprotrusio cage reliably reconstituted the hip joint center and acetabular bone stock. The short-term incidence of mechanical loosening parallels that of previously reported acetabular reconstruction techniques.     

Acetabular revision using a total acetabular allograft

The most challenging aspect of an acetabular revision is the management of severe bone loss, which compromises implant fixation and stability. We present a case of failed acetabular revision with extensive bone loss (Paprosky Type 3b) in a 50-year-old woman with rheumatoid arthritis, which was treated using total acetabular allograft. At a follow-up of 1 year and 3 months, the allograft had united with the host bone. This is the first report of the use of a total acetabular allograft for revision total hip arthroplasty in India. The total acetabular allograft allows the placement of the component closer to the normal hip center, provides initial stability for the acetabular component, and restores bone stock to the host pelvis.     

应用非骨水泥髋臼或金属髋臼支架行髋关节翻修术的临床研究

目的 评估非骨水泥髋臼及金属髋臼支架加植骨修复髋臼骨缺损的效果.方法 我院自2001年9月至2008年9月应用髋臼翻修支架行髋关节翻修术22例(24髋).其中Lima非骨水泥人工翻修髋臼2例(2髋),Kerboull 支架2例(2髋),GAP 髋臼翻修支架18例(20髋).男性6例(6髋),女性16例(18髋).平均年龄62岁(34～79岁).感染性松动2例(2髋),无菌松动20例(22髋).平均随访时间48个月(18～84个月),对其进行临床和影像学评估.Harris评分术前平均为56分(44～75分).结果 末次随访时22例患者Harris评分平均为89分(78～94分).优良率为95.5%(21/22).三种髋臼翻修支架的外展角满意,髋臼旋转中心基本得到了重建.髋臼翻修支架及其聚氯乙烯臼无明显移位,假体周围无透亮线,髋臼植骨愈合良好.结论 应用非骨水泥髋臼或髋臼支架修复髋臼侧巨大骨缺损,重建了髋臼正常旋转中心、提供了翻修假体的初期稳定性、避免了所植骨在血管化时期的过度机械负重,是翻修髋臼巨大骨缺损的可靠方法.     

Acetabular revision with impacted grafting and a reinforcement ring: 42 patients followed for a mean of 10 years

We analyzed the outcome of 42 cemented cup revisions (40 patients) with morselized bone grafts and a reinforcement ring after median 10 (7-16) years. The acetabular component migrated a mean of 7 (5-8) mm in 5 hips. The migration stopped after 2 years except in 1 hip, the only one revised because of mechanical loosening. 3 other hips were revised because of infection. Among the other 38 hips (36 patients), the Merle d'Aubigné score increased from 9 to 15 points.     

Acetabular revision with impacted grafting and a reinforcement ring: 42 patients followed for a mean of 10 years

We analyzed the outcome of 42 cemented cup revisions (40 patients) with morselized bone grafts and a reinforcement ring after median 10 (7-16) years. The acetabular component migrated a mean of 7 (5-8) mm in 5 hips. The migration stopped after 2 years except in 1 hip, the only one revised because of mechanical loosening. 3 other hips were revised because of infection. Among the other 38 hips (36 patients), the Merle d'Aubigné score increased from 9 to 15 points.     

Acetabular revision using grafts and cages

Principles of acetabular revision include stable bone coverage that can support the new acetabular component, restoration of the anatomy and bone stock for future revisions, and equalization of leg length. Achieving these goals depends on the severity of the pelvic defect. Classification of these acetabular defects is critical to optimal treatment choice. A classification formulated by the authors of this paper and based on proven Severity Instrument methodology has been applied effectively at their institutions after meeting reliability and validation criteria. Approaches to acetabular revision based on this classification have resulted in good outcomes.     

髋臼加强杯的应用原则和手术技术

本文介绍了髋臼假体翻修术中不同程度髋臼骨质缺损的处理原则,探讨了生物固定型假体、骨水泥型假体、异型假体、大块同种异体骨移植、髋臼加强杯的手术适应证及临床效果.重点介绍了髋臼加强杯(AmZ)的常见类型和选择原则、手术技术要点、常见手术技术错误等.     

全髋关节翻修术中髋臼严重缺损的钢板重建

目的在全髋关节翻修手术中,通过髋臼钢板对严重的髋臼骨缺损进行重建,恢复髋臼的骨性解剖结构,提高翻修术后髋臼假体的长期稳定性。方法自1998年1月～2000年3月行全髋翻修手术47例,对10例髋臼Ⅲ型缺损和2例髋臼Ⅰ型缺损病例,采用异体松质骨进行髋臼植骨重建后,选用合适的髋臼重建钢板,对重建后的髋臼进行支撑加强,以恢复髋臼骨性结构及强度。结果12例患者平均年龄62岁(37～72岁),术后随访平均9.7个月(6～25个月),在近期随访病例中,髋臼侧异体植骨愈合良好,未出现植骨吸收和塌陷。结论对严重髋臼缺损的病例,采用髋臼重建钢板进行重建,具有植骨方便、早期稳定性好等优点。在临床实践中,近期疗效十分满意,其后期疗效还有待于进一步随访观察。     

Acetabular reconstruction with morcellized allograft and ring support: a medium-term review.

Acetabular bone stock deficiency is commonly encountered in revision hip surgery. A number of techniques are available to address this problem, including the use of particulate allograft with reconstruction rings in an effort to provide a stable construct and replenish bone stock. Our technique and results using such devices in complex acetabular deficiencies are described. In the setting of a large nmedial segmental or cavitary acetabular defect, morcellized bone-graft is used to reconstitute the acetabular floor. This graft is reverse reamed until its depth allows screw fixation of a metallic support ring. The screws also serve to compress the graft. A polyethylene acetabular component is then cemented into the reconstituted acetabulum with full freedom of orientation. A series of 48 patients in whom this technique was employed is presented. These cases have been clinically and radiologically reviewed with a mean follow-up of 64 months (range, 25-102 months). Good bony incorporation with stable acetabular components was seen in all but the two cases in which sepsis predominated.