髋关节翻修术中髋臼骨缺损的处理与重建

目的探讨髋关节翻修术中髋臼骨质缺损的处理和重建方法。方法对28例髋关节置换术后髋臼骨缺损的患者进行翻修,观察术后随访X线片上的髋臼假体及周围骨质变化情况,并对髋关节行Harris功能评定。结果 28例均获随访,随访时间12～184个月,平均61.6个月。1例术后出现脱位,2例术后出现骨溶解并伴患髋疼痛。7例术后随访的X线片上出现髋臼的骨溶解,但髋臼假体无松动表现,患髋无疼痛,患髋功能不受影响。至末次随访为止,25例髋（89%）获得良好的稳定性。术前Harris评分平均31.8分（14～57分）,末次随访时平均85.2分（46～99分）。两组数据具有显著性差异。结论充分的术前准备是手术顺利进行并获得良好效果的一个重要前提,植骨的方式和翻修假体的选择还需结合术中对骨缺损的评价。髋臼假体表面被自体骨覆盖超过50%,可考虑行植骨加非骨水泥型髋臼假体置换;自体骨覆盖不足50%,宜行骨水泥型髋臼假体置换。如骨缺损面积较大,可行加强环等翻修。从随访中可见,颗粒骨打压植骨是治疗髋臼骨缺损可靠的方法。

Treatment and Reconstruction for Acetabular Defects in Total Hip Arthroplasty Revision

Objective To discuss the option of treatments for acetabular defects in the revision of the total hip arthroplasty.Methods Twenty-eight cases of acetabular defects in the revision of the total hip arthroplasty were retrospectively analyzed.The variation of the bone around the acetabulum protheses and the Harris scores were evaluated in follow-up.Results Twenty-eight patients were followed up for 12 to184months（average：61.6months）.Harris′score rose from 31.8 points preoperatively to 85.2 points postoperatively.One case complicated hip dislocation,two cases complicated acetabular bone erosion and hip pain,25 cases had good stability.Conclusion It is essential for a well preoperative provision to obtain a good operative result.The bone implant mode and the choice of revision prothesis should base on the evaluation in operation.The treatment for the acetabular bone defects with the impaction allograft is effective.