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 using acetabular reinforcement cages with a hook

Objective To evaluate the effects of cementless revising cup or acetabular reinforcement cages for reconstructing the massive acetabular deficiency.Methods From September 2001 to September 2008,22 loosening acetabular cases(24 hips)were revised using cementless revising cup or acetabular reinforcement cases for reconstructing massive bone defect after particulate bone grafting.There were 2 cases (2 hips)using Lima cementless revising cup,2 cases(2 hips)using Kerboull ring,and 18 cases(20hips)using restoration GAP cages.Six cases(6 hips)were male,and 16 cases(18 hips)were female.The mean age was 62 years old(34-79 years old).Septic loosening was in 2 cases(2 hips),and aseptic loosening in 20 cases(22 hips).The mean follow-up was 48 months(18-84 months).Results There was no clinical or radiological evidence of loosening for the revising acetabular components at the last follow-up point.The mean Harris hip score was improved significantly from 56 points(44-75)before revision to 89 points(78-94)at the last follow-up after revision.Excellent and good rate was 95.5%(21/22 cases).The average abduction angle of the three types of acetabular reconstructive cages were 50.1°(39.0°-66.0°),and almost all cases of the hip rotation center were restored after revision surgery.At the last follow-up,the reinforcement cages were no immigration and breakup,and there was no radiolucent line around the acetabular components.The bone graft integrated well into surrounding acetabular bone.Conclusion The method of revising the massive acetabular bone defect by cemenfless revising cup and acetabular reinforcement cages restores the normal hip rotation center,supplies the primary stability of the revising component,and protects the bone graft from mechanical overload during its revascularization phase,which is a reliable method for revising the massive acetabular deficiency after total hip arthroplasty.