应用钢板和人工骨行全髋关节股骨侧假体翻修11例

背景：对于股骨假体paprosky分型Ⅲ型、Ⅳ型翻修时,大多数学者趋向于采用非骨水泥涂层的长柄翻修假体。但是,关于骨缺损的植骨材料选择、植骨方式、钢板是否可以采用等问题,在骨科界目前尚未有较成熟的意见。目的：观察同时采用钢板和人工骨进行全髋关节股骨侧假体翻修的疗效。方法：11例股骨侧假体翻修患者（paprosky分型Ⅲ型8例,Ⅳ型3例）均采用现代无骨水泥技术,记忆合金环抱钢板4例,加压钢板或有限接触钛板2例,锁定钛板5例,所有病例均使用异体或异种颗粒骨进行嵌压植骨、异体骨板结合钢丝或线缆握紧系统器械进行结构重建。翻修前后髋关节功能按Harris评分标准进行评价,观察患者手术切口愈合及髋关节活动情况。结果与结论：11例患者均获得随访,平均13.6个月,Harris评分优良9例（82%）,可1例（9%）,差1例（9%）。提示患者股骨侧假体翻修中,同时应用钢板和人工骨进行髋关节股骨侧翻修,能让股骨侧paprosky分型Ⅲ型和Ⅳ型缺损合并假体周围骨折固定快且牢固,生物型假体即刻达到稳定,手术时间和创伤减少,并允许患者早期进行功能锻炼。

Application of plate and artificial bone in the revision of femoral prosthesis in 11 cases

BACKGROUND：Most scholars tend to use long-handled cementless prosthesis for revision of Paprosky Ⅲ and Ⅳ defects.However,there is not a more mature view yet on the implant selection,grafting way,whether the plate is used or not.OBJECTIVE：To review the clinical results of plate and artificial bone in the revision of femoral prosthesis of total hip arthroplasty（RTHA）.METHODS：Eleventh cases（8 cases of Paprosky Ⅲ,3 of Paprosky Ⅳ） underwent RTHA with cementless techniques,including 4 cases of shape-memory alloy surround plate,2 cases of compression plate or limited contact-dynamic compress plate（LC-DCP）,5 cases of LISS.All the cases underwent structural reconstruction with use of mesh,cable grip system,impacted allograft and cortical strut.Harris score was developed before and after the revision,and markers such as incision healing,body temperature,ESR,pain,activities of hip joint,daily life,walking and so on were observed in patients.RESULTS AND CONCLUSION：Postoperative clinical results were evaluated as good in 9 cases（82%）,fair in 1 case（9%） and poor in 1 case（9%） which showed immunoresponse.In RTHA for the femoral component for the elderly patients with Paprosky Ⅲ or Ⅳ defects combined with periprosthetic fracture,application of plate and artificial bone can decrease operation time and trauma,fix femoral component stably and quickly,and allow patients to do early functional exercise.